Local Excision
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Local Excision
Rectal Cancer: Local Excision- Key Concepts
- Techniques
- Complications
- Oncologic Results
- Local Excision and Adjuvant Therapy
- Neoadjuvant Therapy and Local Excision
- Quality of Life
- Salvage Surgery
- Conclusion
- References
- Introduction
- Patient Selection
- T1N0
- Predicting Lymph Node Metastasis
- Depth of Invasion
- Lymphovascular Invasion and Poor Differentiation
- Tumor Budding
- T2
Management of Rectal Cancer (2020)- Colorectal Cancer: Postoperative Adjuvant Therapy and Surveillance
- Gastrointestinal Stromal Tumors, Neuroendocrine Tumors, and Lymphoma
Malignancy- A 75-year-old woman underwent a transanal excision of a cT1N0M0 rectal cancer. The final pathology was T1 with negative margins and no aggressive features. What is the appropriate endoscopic surveillance regimen?
- A 62-year-old man was found to have 1-cm posterior rectal lesion that is 3 cm from the anal verge. Histopathologic findings are consistent with a well-differentiated adenocarcinoma without lymphovascular or perineural invasion. Magnetic resonance imaging shows that the tumor is limited to the submucosa and there are no suspicious mesorectal lymph nodes. Metastatic workup uncovers no findings. What is the most appropriate management?
- A 63-year-old woman is diagnosed with a 1.5-cm, well-differentiated perianal squamous cell cancer that is 3.5 cm from the anal verge, with no involvement of the anal sphincter mechanism. There is no radiographic evidence of inguinal nodal or metastatic disease. The best treatment option for this patient is:
- A 50-year-old woman is found to have a 7-mm submucosal yellow lesion in the distal rectum on screening colonoscopy. There is no pillow sign. What is the most likely diagnosis?
- A 57-year-old man is found to have a submucosal mass in the distal rectum on colonoscopy. Biopsy reveals spindle cells which stain positive for CD117 on immunohistochemistry. The lesion is posterior and 5 cm from the anal verge on rigid proctoscopy. Magnetic resonance imaging measures the size of the lesion as 1.3 cm with extension into the muscularis propria. What is the appropriate treatment?
- A 49-year-old woman was seen in the clinic for hemorrhoids. On examination, a hard nodular area is palpable in the right lateral anal canal wall. You examine the patient under anesthesia and perform a biopsy. The pathology report reveals anal squamous cell carcinoma. Staging imaging reveals a T2N0 lesion with no evidence of metastasis. What is the next step in management?
- A 65-year-old man was diagnosed with a 1.5-cm lesion at the anal verge. Biopsies were positive for S100 and HMB-45. Computed tomography of the chest, abdomen, and pelvis showed no metastases. Which is the next best step in this patient’s treatment?
- Anal Cancer
- Anal Intraepithelial Neoplasia
Malignancy- A 45-year-old man is seen in the clinic for persistent perianal itching. Examination of the perianal skin revealed a 1.5-cm plaque-like lesion at the left lateral position, approximately 2 cm from the anal verge. Punch biopsy of the lesion demonstrates basal cell carcinoma. There is no distant metastatic disease. What is the most appropriate next step in treatment?
- A 64-year-old man presents with a lesion on the perianal skin, as shown in the figure. Biopsy in the office demonstrates verrucous carcinoma. The most definitive management in this patient is
- A 68-year-old woman reports severe anal pain and bleeding. Examination demonstrates a 2-cm ulcerated lesion just proximal to the dentate line. Biopsies reveal BRAF mutation anal melanoma. Imaging demonstrates enlarged presacral and obturator lymph nodes. The best next step in management is
- 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 63-year-old otherwise healthy woman comes to see you for chafing and ulceration related to a perianal skin tag. It has been present ever since she was pregnant years ago; however, in the past 6 months, there is an area that has been bleeding persistently. On examination, she has a large 3-cm perianal skin tag, with a small area of ulceration at the base measuring about 1–2 mm. You take her for excision of this tag, and the pathology comes back as invasive, well-differentiated squamous cell carcinoma, 6 mm in width, with margins negative at least 1 cm from the edge of the specimen. Staging workup and imaging are negative. The recommended next step in treatment is
- Which technical/surgical factor during proctectomy most influences the risk of local recurrence?
- During screening colonoscopy, a 0.9-cm rectal polyp was removed using a saline lift snare polypectomy. Pathology was significant for well-differentiated submucosal neuroendocrine tumor without lymphovascular involvement or penetration into the muscularis propria. What is the best next step in management?
- A 60-year-old woman undergoes screening colonoscopy. A 2.5-cm submucosal lesion is found in the mid-rectum at 8 cm from the anal verge. Biopsy shows a well-differentiated neuroendocrine tumor. The most appropriate next step in treatment is
- A 65-year-old man undergoes screening colonoscopy. A 1-cm submucosal mass is seen in the mid rectum. Biopsy results show spindle cells with KIT (CD117) positivity with a low mitotic rate. Complete staging is performed without any evidence of metastatic or locally advanced tumor. What is the most appropriate management?
- Anorectal Disease
- A 45-year-old woman presents with induration and chronic draining sinuses in the perineum, axilla, and groin. She underwent a screening colonoscopy 2 years ago, the result of which was normal. What is the best long-term management strategy to prevent recurrence?
- A 53-year-old woman presents with a 3×2–cm pruritic, well-circumscribed, eczematous, tender lesion that does not involve the anal verge. A punch biopsy notes intradermal infiltration of cells with large, round, eccentric nuclei, with pale vacuolated cytoplasm, which stain positive for cytokeratin 7. Workup is negative for malignancy. What is the best step in management?
- A 56-year-old HIV positive man with anal condyloma acuminata undergoes excision and fulguration of these lesions under general anesthesia. The pathology shows foci of high-grade dysplasia related to human papillomavirus. What is the next step in the management?
- A 55-year-old man presents with multiple perianal and anal canal condylomas. The patient undergoes an examination under anesthesia and excision. Which of the following techniques is most appropriate?
- Colorectal Cancer: Preoperative Evaluation and Staging
- Locally Recurrent Rectal Cancer
- Complications of the Pelvic Pouch
- Pilonidal Disease and Hidradenitis Suppurativa
- Rationale for Multimodality Therapy
- Anorectal Disease
- A 73-year-old woman has been followed for a chronic posterior anal fissure with continued bright red blood spotting which has failed to heal with medical management including calcium channel blockers. On digital rectal examination, the patient has decreased tone and an anorectal manometry demonstrates slightly decreased anal pressures. What is the best next treatment for her?
- A 73-year-old, otherwise healthy woman reports 6 months of perianal itching. Examination reveals a left-sided, scaly perianal skin rash. A biopsy reveals large cells that contain pale, clear cytoplasm with a large nucleus. Colonoscopy and computed tomography (CT) of the chest, abdomen, and pelvis are normal. What is the best treatment option?
- Proctectomy for Rectal Cancer
- Rectal Cancer: Nonoperative Management
- Hemorrhoids
- Anal Squamous Cell Cancers (Revised 2018)
- Rectal Cancer: Neoadjuvant Therapy
- Colon Cancer Surgical Treatment: Principles of Colectomy
- Tailored Mesorectal Excision
- Management of Rectal Cancer 2023 Supplement (2023)
- Indications for LAR Versus Intersphincteric Resection Versus APR
- Management of Local Recurrences
- Rectal Cancer Pathology Assessment