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
Management of Local Recurrences
Malignancy- 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
- 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
Malignancy- A 64-year-old man received neoadjuvant chemoradiotherapy followed by a low anterior resection 3 years ago for the treatment of rectal cancer. He complains of persistent fecal urgency, occasional fecal incontinence, clustered stools, and incomplete evacuation, which has persisted since the time of surgery. What is the most likely cause of these symptoms?
- 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?
- Indications for Extended Resection
Management of Colon Cancer (2022)- Proctectomy for Rectal Cancer
- Local Excision
- Technique of Total Mesorectal Excision
- About ASCRS Textbook of Colon and Rectal Surgery
- Preoperative Staging
- Colon and Rectal Surgery Educational Program (CARSEP)
- Adjuvant Therapy for Rectal Adenocarcinoma
- Anal Cancer
- Rectal Cancer: Neoadjuvant Therapy
- Management of Rectal Cancer (2020)
- Rectal Cancer: Local Excision
- Colorectal Cancer: Postoperative Adjuvant Therapy and Surveillance
- Surveillance and Survivorship Care of Patients After Curative Treatment of Colon and Rectal Cancer (2021)
- Anal Squamous Cell Cancers (Revised 2018)
- Rectovaginal Fistula
- Colorectal Cancer: Management of Distant Metastases