Rectal Cancer

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document Rectal Cancer (Chapter 26, European Manual of Medicine: Coloproctology Second Edition) Popular

Published on 18 May 2017 By European Manual of Medicine: Coloproctology In Rectal Cancer

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Rectal cancer should be managed by a multidisciplinary team (MDT) that includes input from gastroenterology, radiology, pathology, radiation oncology, and oncology in addition to colorectal surgery. The workup of suspected rectal cancer includes digital rectal examination, rectoscopy (proctoscopy), and biopsy. Staging of the tumor requires thoracic/abdominal computed tomography, pelvic magnetic resonance imaging, and complete colonoscopy to assess local tumor growth, systemic spread, and synchronous colonic lesions. The findings should be discussed during an MDT conference to determine the optimal sequence of treatment and the timing and extent of surgical resection. Radiotherapy, which is best delivered preoperatively, reduces the risk of local recurrence and may enhance survival in high-risk patients. Concomitant chemotherapy is used to increase the effect of radiotherapy (chemosensitizing radiation). Complete resection of the rectum en bloc with the surrounding mesorectal envelope enclosing draining lymphatic tissue, called total mesorectal excision, is the gold standard to decrease the risk of local recurrence and avoid injury to adjacent pelvic structures. Rectal cancers in the middle and upper third of the rectum can be treated with sphincter-saving anterior resection and colorectal anastomosis. Cancer in the lower third of the rectum may be amenable to low anterior resection with coloanal anastomosis or require abdominoperineal excision. Tumors involving the pelvic floor or external anal sphincter are treated with extralevator abdominoperineal excision and permanent colostomy. Preoperative chemoradiotherapy may result in complete clinical and radiological response. Such patients may enter a watch-and-wait program of intensive surveillance to detect tumor regrowth. Review of the surgical specimen pathology during a postoperative MDT meeting is important to ensure treatment quality and to determine the potential need for adjuvant chemotherapy. Follow-up after treatment, to detect metachronous colorectal cancer, local recurrence, or systemic disease, should continue for 5 years. Surgery and radiotherapy have adverse effects on function of the bowel, urinary bladder, sexual organs, and gonads, which warrant attention both at the onset of treatment and during follow-up.

video Total InterSphincteric Resection followed by Transanal TME

Published on 19 May 2017 By ESCP Secretariat In Rectal Cancer

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As part of taTME month, Quentin Denost, Centre Hospitalier Universitaire Bordeaux, explores using the procedure following total ISR in female.

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