Proctectomy for Rectal Cancer
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Proctectomy for Rectal Cancer- Key Concepts
- References
- Background
- Anatomy of the Rectum and Mesorectum
- Priorities in Proctectomy for Rectal Cancer
- Preoperative Preparation
- Operative Approaches
- Open Low Anterior Resection
- Straight Stapled Anastomosis
- Reconstruction After APR
- Low Anterior Resection Syndrome
- Multivisceral or Extended Resections
- Handsewn Coloanal Anastomosis
- Colonic J-Pouch Anastomosis
- End-to-Side Anastomoses
- Transverse Coloplasty
- Laparoscopic Low Anterior Resection
- Robotic Low Anterior Resection
- Transanal Total Mesorectal Excision
- Abdominoperineal Resection
- Oncologic Outcomes
- Multidisciplinary Rectal Cancer Care
- Conclusion
- Colorectal Cancer: Postoperative Adjuvant Therapy and Surveillance
- Colorectal Cancer: Minimally Invasive Surgery
- Rectal Cancer: Nonoperative Management
- Rectal Cancer: Local Excision
Rationale for Multimodality Therapy- Local Excision
Malignancy- A 25-year-old obese female patient with a known diagnosis of familial adenomatosis polyposis is preparing for prophylactic surgery. Colonoscopy reveals more than 200 small polyps in her colon with no significant polyps distal to the sigmoid. She desires to have children as soon as possible. Which surgical option will minimize her cancer risk while giving her the best chance of preserving fertility?
- 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 64-year-old man with a midrectal cancer undergoes neoadjuvant therapy and subsequent total mesorectal excision with anastomosis. After surgery, he complains of urge urinary incontinence and retrograde ejaculation. Which of the following aspects of the operative procedure are responsible for his postoperative 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?
- A 68-year-old man with a history of a hemorrhoidectomy and fecal urgency presents with a T3n1m0 rectal cancer 5 cm from the anal verge. He has no family history of colorectal cancer. What is the most important consideration when counseling the patient about his surgical treatment options?
- Rectal Cancer Biology and Hereditary Cancer Syndromes
Malignancy- 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?
- Which technical/surgical factor during proctectomy most influences the risk of local recurrence?
- Colorectal Cancer: Preoperative Evaluation and Staging
Management of Inherited Adenomatous Polyposis Syndromes (2024)- Rectal Cancer: Neoadjuvant Therapy
- About ASCRS Textbook of Colon and Rectal Surgery
- Sporadic and Inherited Colorectal Cancer: How Epidemiology and Molecular Biology Guide Screening and Treatment
- Rectal Cancer Pathology Assessment
- General Postoperative Complications
- Anal Cancer
- Locally Recurrent Rectal Cancer
- Sexual Dysfunction and Its Management
- Bowel Dysfunction Low Anterior Resection Syndrome
- Rectovaginal Fistula
- Low Anterior Resection Syndrome (LARS)
- Management of Rectal Cancer 2023 Supplement (2023)
- Perioperative
- Benign Disease