Editor's Note: From August 5th to 10th, 2024, the Guangzhou Colorectal Cancer Summit Forum and the 22nd Guangdong Provincial Colorectal Cancer Academic Conference were held in Guangzhou. During the event, Dr. Jin Gu from Peking University Shougang Hospital shared important insights and conclusions from his center’s experience with combined pelvic organ resection surgery for refractory rectal cancer. After the conference, we had the privilege of interviewing Professor Gu.

Oncology Frontier: Despite some progress in comprehensive rectal cancer treatment in recent years, leading to a significant reduction in postoperative local recurrence rates, a considerable number of patients still experience local recurrence. How do you think we can better identify and reduce the risk of recurrence in high-risk patients post-surgery and improve their survival rates?

Dr. Jin Gu: I believe the most important step is to promote standardized diagnosis and treatment protocols for rectal cancer. For patients with locally advanced rectal cancer, it is crucial to administer standardized preoperative chemoradiotherapy, as outlined in both national and international guidelines. However, only about 30% of eligible patients in China currently receive preoperative chemoradiotherapy. This low percentage is likely due to various factors, including a lack of awareness among doctors about treatment standards. Therefore, I think promoting standardized rectal cancer diagnosis and treatment across the country remains a significant challenge.

Oncology Frontier: Combined pelvic organ resection is currently considered the best option for some patients with locally advanced or recurrent rectal cancer. However, the procedure is complex, involving extensive resection and carrying high risks of complications and perioperative mortality. Could you share your clinical experience and insights in this area?

Dr. Jin Gu: At the conference, we shared our surgical experience with 196 patients with refractory rectal cancer who underwent combined pelvic organ resection (PE). Based on our experience, for cases involving recurrence and higher surgical difficulty—such as patients requiring a second surgery or elderly patients with multiple complications—we recommend PE after a thorough MDT evaluation confirms that the patient can tolerate the procedure. Even though the surgery is challenging, if we carefully select patients and achieve an R0 resection, these patients can still benefit significantly from the surgery. Among the 196 rectal cancer patients we studied, the proportion with distant metastasis was about 50%. While caution is advised in performing PE on patients with distant metastasis, and it is not generally recommended, we found that many younger patients and their families remain highly motivated to pursue treatment even after distant metastasis occurs. Through careful analysis, we found that even in the presence of distant metastasis, comprehensive treatment can reduce the risk and improve disease control. In such cases, resecting the pelvic tumor can still benefit the patient. Our most important conclusion from this study is that patients with distant metastasis can be categorized into high-risk and low-risk groups. For the high-risk group, such as those with lung metastasis and elevated CA242 levels, PE may not be necessary. However, for low-risk patients with one or two marginal liver metastases and pelvic organ recurrence, combined pelvic organ resection can be beneficial.

Oncology Frontier: Multidisciplinary treatment is particularly important for locally recurrent rectal cancer. How do you think we can further enhance and improve the prognosis of colorectal cancer patients through multidisciplinary collaboration in clinical practice?

Dr. Jin Gu: First, we should make good use of the latest clinical research results to identify more patients who can benefit from preoperative treatment. Currently, after comprehensive preoperative treatment, including immunotherapy, chemotherapy, and radiotherapy, many patients with locally advanced rectal cancer achieve complete remission, with CR rates reaching as high as 80% to 90%, especially in cases of MSI-H colorectal cancer. These patients can avoid surgery after preoperative comprehensive treatment, reducing the pain associated with surgery, improving quality of life, and conserving medical resources. The emergence of new treatment methods and technological advancements has enabled patients who were previously deemed incurable to achieve complete remission through chemotherapy, radiotherapy, or immunotherapy alone, thus avoiding surgery. This is a significant advancement in the field of rectal cancer in recent years.

Expert Profile

Jin Gu

• Professor, Chief Physician, and Doctoral Supervisor at Peking University Cancer Hospital
• President of Peking University Shougang Hospital
• M.D., FACS, FASCRS(HON)
• Chairman of the Chinese Medical Association Oncology Society (9th Term)
• Chairman of the Colorectal Cancer Committee of the Chinese Anti-Cancer Association (6th Term)
• Deputy Leader of the Colorectal and Anal Surgery Group of the Chinese Society of Surgery
• Fellow of the American College of Surgeons (FACS)
• Honorary Member of the American Society of Colon and Rectal Surgeons (FASCRS HON)
• Foreign Academician of the French National Academy of Surgery
• Vice President of the Beijing Medical Association
• Member of the 11th, 12th, and 13th National People’s Congress
• First Special Supervisor of the National Supervisory Commission