Surgical Treatment of Rectal Cancer: Local Resection

Perretta, Silvana; Guerrero, Víctor Hugo Guerrero; Garcia‐Aguilar, Julio

doi:10.1016/j.soc.2005.10.001

Cited by 14 publications

(9 citation statements)

References 108 publications

(160 reference statements)

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Systemic recurrence rates ranged from 6% to 21% for local excision and from 2% to 9% for radical surgery. Mellgren et al [8] reported local recurrence rates at 5 years of 18% for T1 and 47% for T2 cancers. Subsequent salvage surgery was performed in 24 of 27 patients with recurrence.…”

Section: Discussionmentioning

confidence: 99%

The indication and surgical results of local excision following radiotherapy for low rectal cancer

et al. 2009

View full text Add to dashboard Cite

show abstract

Section: Discussionmentioning

confidence: 99%

The indication and surgical results of local excision following radiotherapy for low rectal cancer

et al. 2009

View full text Add to dashboard Cite

show abstract

“…After standard TAE, local recurrence has been reported from 0 to 28 % for T1 tumors and overall survival from 74 to 90 %. 45 You et al 35 retrospectively compared the outcomes of 2,124 patients reported to the National Cancer Database and found significantly increased rates of recurrence among patients undergoing local versus standard excision of T1 rectal cancers (12.5 versus 6.9 %, p=0.003), but on multivariate analysis, the type of surgery was not a significant predictor of 5-year overall survival. Local recurrence after TEM has been reported from 0 to 11 % for good risk T1 rectal tumors.…”

Section: Choice Of Techniquementioning

confidence: 99%

Sphincter-Sparing Surgery in Patients with Low-Lying Rectal Cancer: Techniques, Oncologic Outcomes, and Functional Results

Bordeianou

Maguire

Alavi

et al. 2014

Journal of Gastrointestinal Surgery

View full text Add to dashboard Cite

Background Rectal cancer management has evolved into a complex multimodality approach with survival, local recurrence, and quality of life parameters being the relevant endpoints. Surgical treatment for low rectal cancer has changed dramatically over the past 100 years. Discussion Abdominoperineal resection, once the standard of care for all rectal cancers, has become much less frequently utilized as surgeons devise and test new techniques for preserving the sphincters, maintaining continuity, and performing oncologically sound ultra-low anterior or local resections. Progress in rectal cancer surgery has been driven by improved understanding of the anatomy and pathophysiology of the disease, innovative surgical technique, improved technology, multimodality approaches, and increased appreciation of the patient's quality of life. The patient with a low rectal cancer, once almost universally destined for impotence and a colostomy, now has the real potential for improved survival, avoidance of a permanent stoma, and preservation of the normal route of defecation.Keywords Rectal cancer . Sphincter preservation . Total mesorectal excision . Anterior resection . Intersphincteric resection . Local excision rectal cancer Historical BackgroundThe modern era of rectal cancer surgery began with the description of the abdominoperineal resection (APR) by Miles in 1908. Prior perineal and sacral approaches (e.g., Kraske approach) to rectal cancer resection produced high rates of complications, cancer recurrence, poor quality of life (QOL), and poor overall survival. Miles' operation reflected greater understanding of the natural history of rectal cancer that was based on postmortem examination of his patients after perineal resection. He observed cancerous implants in the pelvic peritoneum, mesorectum, and affected nodes of the left common iliac bifurcation. These findings led him to develop a "cylindrical concept" of the spread of rectal cancer to upward, downward, and lateral zones. 1 The original operation included resection of the rectum, sigmoid, mesorectum, nodes of the iliac bifurcation, and a perineal component to include the anus and levator ani muscles. Postoperative mortality was high initially, but local recurrence decreased

show abstract

“…Local excision for rectal cancer has many merits, because it can eliminate defecation, sexual and urinary dysfunction, and can prevent the need for a permanent stoma. It is also associated with a shorter hospital stay, and minimal mortality and morbidity because it avoids radical surgery [ 5 , 6 , 9 , 94 , 103 , 135 – 137 ]. However, the relatively high recurrence rate has become an issue that has hindered the further application of the local excision of rectal cancer [ 7 , 9 ].…”

Section: Goals Of Local Excisionmentioning

confidence: 99%

When is local excision appropriate for “early” rectal cancer?

2013

View full text Add to dashboard Cite

Local excision is increasingly performed for “early stage” rectal cancer in the US; however, local recurrence after local excision has become a controversial issue in Western countries. Local recurrence is considered to originate based on the type of tumor and procedure performed, and in surgical margin-positive cases. This review focuses on the inclusion criteria of “early” rectal cancers for local excision from the Western and Japanese points of view. “Early” rectal cancer is defined as T1 cancer in the rectum. Only the tumor grade and depth of invasion are the “high risk” factors which can be evaluated before treatment. T1 cancers with sm1 or submucosal invasion <1,000 μm are considered to be “low risk” tumors with less than 3.2 % nodal involvement, and are considered to be candidates for local excision as the sole curative surgery. Tumors with a poor tumor grade should be excluded from local excision. Digital examination, endoscopy or proctoscopy with biopsy, a barium enema study and endorectal ultrasonography are useful for identifying “low risk” or excluding “high risk” factors preoperatively for a comprehensive diagnosis. The selection of an initial local treatment modality is also considered to be important according to the analysis of the nodal involvement rate after initial local treatment and after radical surgery.

show abstract

Surgical Treatment of Rectal Cancer: Local Resection

Cited by 14 publications

References 108 publications

The indication and surgical results of local excision following radiotherapy for low rectal cancer

The indication and surgical results of local excision following radiotherapy for low rectal cancer

Sphincter-Sparing Surgery in Patients with Low-Lying Rectal Cancer: Techniques, Oncologic Outcomes, and Functional Results

When is local excision appropriate for “early” rectal cancer?

Contact Info

Product

Resources

About