Surgical options for locally recurrent rectal cancer—review and update

Abstract

Locally recurrent rectal tumours in the pelvis are found in about 6% following treatment for rectal cancer. This type of tumour can cause serious local complications and symptoms. The aim of modern surgical oncology is to offer a curative treatment option embedded in an interdisciplinary network of specialities to the patient. Due to advancements in surgical techniques and procedures, especially regarding surgical reconstruction, the possibilities of a curative treatment regarding recurrent cancers have been expanded and established. To aim for a curative treatment one must introduce a multimodal therapy including radio- and chemotherapy, and a radical oncological surgery with en bloc resection of the tumour and affected surrounding organs to achieve a R0-resection.

The selection process can improve the outcome in locally advanced and recurrent colorectal cancer: activity and results of a dedicated multidisciplinary colorectal cancer centre

“…It is also well established that surgery by trained specialists, especially in rectal cancer, results in an improved outcome . The identification of patients eligible for surgery is a key element in optimizing the surgical results and survival .…”

Factors affecting outcomes following pelvic exenteration for locally recurrent rectal cancer

“…In addition, resection of adjacent muscles, ligaments, and neurovascular and/or bony structures may be necessary to achieve an R0 resection. In recent decades, there have been numerous modifications in techniques to provide more selective resection of the necessary viscera and surrounding structures.…”

Analysis of anatomical variations of intrapelvic vessels for advanced pelvic surgery

“…Asterisk (*) represents the medial internal iliac vein (IIV); dagger ( † ) represents the lateral IIV; double dagger ( ‡ ) represents the internal iliac artery (IIA); hash sign ( # ) represents the venous loop between the two IIVs, which has formed in front of the sacral nerve plexus; and the section sign ( § ) represents the external iliac vein. IIA, internal iliac artery IIV, internal iliac vein; L5, 5th lumbar nerve; S1, 1st sacral nerve; S2, 2nd sacral nerve; SGA, superior gluteal artery treatments, surgical resection is one of the options for cure, in which we must perform radical surgery with en bloc resection with involved surrounding organs including internal iliac vessels to achieve tumor-free resection [12][13][14]. Understanding the above vascular variations might be valuable to prevent inadvertent intraoperative bleeding from the internal iliac vessels in such advanced surgeries.…”