Locally Recurrent Rectal Cancer
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Locally Recurrent Rectal Cancer- Key Concepts
- Introduction
- General Considerations
- Patterns of Local Recurrence and Anatomical Considerations
- Patient Selection and Treatment Planning
- Imaging
- Multidisciplinary Team Assessment
- Resectability
- Metastatic Disease
- Neoadjuvant and Intraoperative Treatment
- Technical Considerations
- Preparation
- Positioning
- Exploration and Preparing the Pelvis
- Central Recurrences
- Composite Pubic Bone Resection
- Lateral Neurovascular Resection
- Posterior Recurrences
- Reconstruction
- Postoperative Management
- Outcomes
- Conclusions
- References
- Rectal Cancer: Local Excision
Local Excision- Management of Local Recurrences
- Indications for Preoperative Neoadjuvant Therapy
- Proctectomy for Rectal Cancer
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 64-year-old woman undergoes colonoscopy for a positive fecal immunochemical test result. A mass is found in the midrectum (Figure). Pathology findings show an adenocarcinoma. For local staging of the tumor, what is the most appropriate next study to perform?
- A 56-year-old man presents to the office with biopsy-proven midrectal adenocarcinoma on colonoscopy. Rigid sigmoidoscopy in the office shows a 5-cm circumferential mass 8 cm from the anal verge. Staging evaluation with computed tomography of the chest, abdomen, and pelvis and magnetic resonance imaging of the pelvis preoperatively demonstrates a T3N1M0 cancer. What is the next step in management for this patient?
- A 72-year-old patient with severe systolic congestive heart failure and oxygen-dependent chronic obstructive pulmonary disease completes chemoradiation for a locally advanced rectal adenocarcinoma 5-cm proximal to the anal verge. Reexamination of the rectum 8 weeks after chemoradiation reveals normal, intact mucosa, and magnetic resonance imaging of the pelvis reveals no visible cancer or suspicious mesorectal nodes. What is the most appropriate therapy for this patient?
- 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 53-year-old man is diagnosed with rectal adenocarcinoma 7 cm from the anal verge. Preoperative pelvic magnetic resonance imaging (MRI) demonstrates a threatened circumferential radial margin. After total neoadjuvant chemoradiation, a repeat MRI demonstrates a persistently threatened radial margin. Which of the following adjuncts should be considered in operative planning for this patient?
- Colorectal Cancer: Preoperative Evaluation and Staging
- Rationale for Multimodality Therapy
- Colorectal Cancer: Postoperative Adjuvant Therapy and Surveillance
Malignancy- A synoptic pathology report of a rectal cancer specimen reads as moderately differentiated adenosquamous carcinoma with negative distal margin measuring >2 cm and a circumferential resection margin (CRM) measuring >2.5 mm. All 12 nodes are negative for metastasis, and there is positive extramural invasion. Which of these features is associated with higher risk for distant recurrence?
- A 60-year-old man undergoes diagnostic colonoscopy for a 6-month history of rectal bleeding and is found to have a 3-cm mass in the mid rectum. Biopsies reveal invasive adenocarcinoma. Staging computed tomography (CT) of the chest/abdomen/pelvis reveals no evidence of distant metastatic disease. Magnetic resonance imaging (MRI) of pelvis reveals a T3 mid-rectal mass, with evidence of enlarged mesorectal lymph nodes. His carcinoembryonic antigen (CEA) level is elevated to 7.5 ng/mL. In this patient, the use of neoadjuvant chemoradiation would be expected to provide which of the following?
- A 63-year-old woman is diagnosed with a poorly differentiated microsatellite–stable rectal cancer 7 cm from the anal verge on screening colonoscopy. She denies trouble with continence. Staging computed tomography (CT) of the chest/abdomen/pelvis does not demonstrate distant disease; a mass is confirmed in the mid rectum with evidence of lymphadenopathy. Rectal magnetic resonance imaging (MRI) demonstrates this tumor is a T4aN2M0 with threatened circumferential radial margin. The multidisciplinary tumor board recommends total neoadjuvant chemotherapy with FOLFOX and long-course chemoradiation therapy. Six weeks after completing neoadjuvant therapy, flexible sigmoidoscopy demonstrates persistent tumor. Restaging MRI after total neoadjuvant therapy is consistent with persistently threatened posterior radial margin with tumor extending to the presacral fascia. The multidisciplinary tumor board’s best recommendation for her is
- Which technical/surgical factor during proctectomy most influences the risk of local recurrence?
- A 67-year-old man with cT3cN0 with threatened circumferential radial margin chooses to undergo primary surgery without neoadjuvant chemoradiotherapy. The clinical impact of a curative resection (R0) versus R1 resection is increased rate of
Management of Rectal Cancer (2020)- Rectal Cancer: Nonoperative Management
- Indications for Extended Resection
- Rectal Cancer: Neoadjuvant Therapy
- Surveillance After Rectal Cancer Treatment
- Anorectal Disease
- Management of Colon Cancer (2022)
- Benign Disease
- Rectal Cancer Pathology Assessment
- Management of Rectal Cancer 2023 Supplement (2023)
- Surveillance and Survivorship Care of Patients After Curative Treatment of Colon and Rectal Cancer (2021)
- Colorectal Cancer: Minimally Invasive Surgery
- Indications for LAR Versus Intersphincteric Resection Versus APR