Rectal Cancer International Perspectives on Multimodality Management
This cutting-edge book delivers state of the art information on the evaluation and management of rectal cancer. Covering the spectrum of clinical management from initial evaluation and staging, to advances and controversies in management, to survivor outc
- PDF / 1,930,637 Bytes
- 15 Pages / 439.37 x 666.142 pts Page_size
- 24 Downloads / 195 Views
Local Excision Y. Nancy You and Heidi Nelson Introduction
Key outcome measures of successful management of rectal cancer involve maximizing survival benefit, minimizing disease recurrence in the pelvis, and preserving preoperative bowel function and health-related quality of life. To achieve these goals, surgical options range from local excision (LE) of tumor to extended multivisceral resections. In addition, adjuvant radiation therapy (RT) and chemotherapy can be combined with surgical resection. Tailoring the optimal treatment regimen for an individual patient involves matching the patient’s disease burden to the extent of surgical resection and additional therapies, in order to achieve the best balance of all aforementioned treatment goals. With increasing interest in sphincter-preservation, local management of rectal cancer has gained appeal in recent years, particularly for patients with early-stage rectal cancer. A critical examination of the advantages and pitfalls of LE is therefore relevant today. The most common local management option is transanal tumor excision, either via conventional technique or via an operating microscope (transanal endoscopic microsurgery, TEMS). Other LE approaches, such as the posterior trans-sacral proctotomy of Kraske, are infrequently seen in practice today and will not be the focus of subsequent discussion. Standard resection (SR) techniques, as referred to in this chapter, will be defined to include abdominal perineal resection (APR), coloanal anastomosis, and/or low anterior resection (LAR). This chapter aims to summarize the current controversies, the technical details, and relevant evidence surrounding the use of LE as potentially curative therapy for stage I rectal cancer.
Historical Perspective and Relevance to Clinical Practice Today Historically, LE was performed to palliate patients who were unfit candidates for SR procedures, either because of age or because of medical comorbidities; alternatively, it was performed for patients who adamantly refused SR and the risk of a permanent colostomy.
From: Current Clinical Oncology: Rectal Cancer, Edited by: B.G. Czito and C.G. Willett, DOI: 10.1007/978-1-60761-567-5_3, © Springer Science+Business Media, LLC 2010 37
38
Y.N. You and H. Nelson
In 1977, Morson et al reported results from patients treated under a policy of LE or “total biopsy” for early rectal cancer as long as it was deemed technically feasible. Among 91 patients with R0 resection, the crude 5-year overall survival (OS) rate was 82% and disease recurred in only three patients. This study encouraged surgeons to perform LE for technically accessable low rectal cancers as long as its histology was not poorly differentiated. In the meantime, it cautioned that, if positive resection margin or unfavorable histology were found on pathology, further transabdominal resections should be performed (1). Since then, experience with LE has accumulated. Today, LE is being increasingly offered as a potentially curative resection for patients with stage I rectal cancer.
Data Loading...
