Proctectomy for Rectal Cancer
11 results
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Malignancy- A healthy 51-year-old man has a poorly differentiated right colon adencarcinoma with mucinous features and mismatch repair (MMR) deficient protein expression. After germline testing was performed, a diagnosis of Lynch syndrome made. The patient reports no issues with incontinence to gas or stool. What is the recommended surgery in this patient?
- A 61-year-old man is found to have a 2-cm mass in the mid-rectum (8 cm from the anal verge) on diagnostic colonoscopy. Biopsy reveals moderately differentiated adenocarcinoma. Computed tomography (CT) reveals no evidence of metastatic disease, and magnetic resonance imaging (MRI) demonstrates a cT3, node-negative cancer. After presentation at a multidisciplinary tumor board, the patient agrees to total neoadjuvant therapy. The patient has a complete clinical response to treatment and opts for close radiologic and endoscopic surveillance in an effort to avoid surgery. On a surveillance proctoscopy 6 months after treatment, the patient is found to have a 7-mm recurrence at the original cancer site. Which of the following is the best next step in management?
- A 45-year-old man undergoes a screening colonoscopy, which shows a 1.5-cm polyp in the rectum located 5 cm from the anal verge. Biopsy reveals well-differentiated invasive adenocarcinoma without lymphovascular invasion, perineural innovation, or tumor budding. Staging computed tomography (CT) does not show any evidence of metastatic disease, and his carcinoembryonic antigen (CEA) level is normal. Magnetic resonance imaging (MRI) of the pelvis reveals the polyp to be a T-1 lesion without any evidence of lymph node metastasis. What is the most appropriate next step in treatment?
- A 57-year-old man undergoes total neoadjuvant therapy (TNT) for management of a cT3N1M0 rectal cancer. After completion of both chemotherapy/radiotherapy and consolidation chemotherapy, the presence of complete clinical response to treatment is assessed by
- A 64-year-old man recently underwent low anterior resection for stage III adenocarcinoma (T3, N1) of the mid-rectum after neoadjuvant chemoradiotherapy. He reports mild urinary incontinence and that he can achieve an erection and orgasm but does not ejaculate. Injury to which nerve structures is the most likely cause of his symptoms?
- A 64-year-old man underwent a low anterior resection 3 months ago for rectal cancer. He presents to your clinic for a follow-up visit where he reports troubles with inability to achieve erection and urinary retention. These symptoms are most likely a result of injury to nerves that originate from which location?
- Which technical/surgical factor during proctectomy most influences the risk of local recurrence?
- A 55-year-old male patient presents to the clinic for evaluation of intermittent fecal incontinence and fecal urgency. The patient has a history of stage III rectal cancer for which he completed total neoadjuvant therapy (TNT) and low anterior resection (LAR) with diverting loop ileostomy. He is now 3 months status post ileostomy reversal. Despite fiber supplementation and intermittent antidiarrheal medication use, he experiences stool stacking and incomplete evacuation 3 days per week. The patient’s symptoms are consistent with
- Benign Disease
- Perioperative
- A 45-year-old man with history of rectal cancer found at 5 cm from the dentate line, underwent low anterior resection. Foley catheter was placed without complication at the start of the surgery. The urine output is appropriate and clear. When should the foley catheter be removed?
- A 77-year-old man has recently undergone a low anterior resection with diverting loop ileostomy for rectal cancer after total neoadjuvant therapy. His hospital course was routine, and he was sent home on postoperative day 4. The patient presents back to the clinic 3 weeks after the index operation. He reports urinary retention, pelvic pain, and bloating. You note an overall failure to thrive. Which test is the most likely to correctly diagnose this patient’s problem?