Colorectal cancer
1. The Code gives very clear instructions on colorectal cancer staging and related examinations. For primary rectal cancer, magnetic resonance imaging or intra-abdominal ultrasound staging examination is recommended, and the specific examination means selected can be combined with the specific conditions of local hospitals. Chen Changhuai, Department of Oncology, Guang’anmen Hospital, Chinese Academy of Traditional Chinese Medicine
For locally resectable rectal cancer, if the preoperative staging is T3 or T1~2N+, neoadjuvant radiotherapy is recommended, while for rectal cancer with preoperative staging of T4, in order to avoid blind palliative resection, neoadjuvant radiotherapy is considered as necessary treatment in the Code.
3. The Code stipulates that for rectal cancer diagnosed as stage II to III (T3-4 or lymph node positive) according to postoperative pathology, if radiotherapy is not administered preoperatively, simultaneous radiotherapy should be administered postoperatively, while for inoperable or locally advanced rectal cancer, preoperative radiotherapy is recommended and surgical resection should be pursued.
4. The Code does not address issues that are still controversial in clinical practice, such as the application of laparoscopic surgery for colorectal cancer, so the risks associated with these unclear issues should be avoided as much as possible in clinical work.
5. The Code also mentions contents about postoperative rehabilitation and enterostomy consultation care.
Gastric cancer
The quality control of T/N pathological staging is particularly emphasized in the Code. The prognosis of patients is greatly influenced by whether the plasma membrane of gastric cancer is invaded or not, especially the differentiation between subplasma membrane cancer (T3) and plasma membrane invasion (T4a) is more important and must be determined by chain sections.
2. In surgery for the purpose of radical treatment, the scope of resection should be decided in such a way that the distance from the cut edge to the tumor margin is sufficient, and it must be ensured that the cut edge distance is at least 3 cm for limited tumors above T2 and at least 5 cm for invasive tumors.
3. The treatment framework of gastric cancer should be based on multidisciplinary collaboration, and individualized treatment should be achieved as much as possible so that patients can benefit the most. Individualized treatment is the future direction of development, including surgery, drug treatment and prevention, etc. Multidisciplinary collaboration is an important part of standardized treatment of gastric cancer.
4. The scope of lymph node dissection is most discussed in the Code. With the results of several large randomized clinical trials, for progressive gastric cancer, D2 lymphatic dissection as the standard radical surgery for gastric cancer is gradually recognized by western scholars. In order to bring maximum survival benefit to patients, local radiotherapy after D0 resection or D1 resection combined with perioperative adjuvant chemotherapy must be performed if standard radical surgery is not possible.