Modern management of rectal cancer: A 2006 update Journal Article
| Authors: | Balch, G. C.; De Meo, A.; Guillem, J. G. |
| Article Title: | Modern management of rectal cancer: A 2006 update |
| Abstract: | The goal of this review is to outline some of the important surgical issues surrounding the management of patients with early (T1/T2 and NO), as well as locally advanced (T3/T4 and/or N1) rectal cancer. Surgery for rectal cancer continues to develop towards the ultimate goals of improved local control and overall survival, maintaining quality of life, and preserving sphincter, genitourinary and sexual function. Information concerning the depth of tumor penetration through the rectal wall, lymph node involvement, and presence of distant metastatic disease is of crucial importance when planning a curative rectal cancer resection. Preoperative staging is used to determine the indication for neoadjuvant therapy as well as the indication for local excision versus radical cancer resection. Local excision is likely to be curative in most patients with a primary tumor which is limited to the submucosa (T1N0M0), without high-risk features and in the absence of metastatic disease. In appropriate patients, minimally invasive procedures, such as local excision, TEM, and laparoscopic resection allow for improved patient comfort, shorter hospital stays, and earlier return to preoperative activity level. Once the tumor invades the muscularis propria (T2), radical rectal resection in acceptable operative candidates is recommended. In patients with transmural and/or node positive disease (T3/T4 and/or N1) with no distant metastases, preoperative chemoradiation followed by radical resection according to the principles of TME has become widely accepted. During the planning and conduct of a radical operation for a locally advanced rectal cancer, a number of surgical management issues are considered, including: (1) total mesorectal excision (TME); (2) autonomic nerve preservation (ANP); (3) circumferential resection margin (CRM); (4) distal resection margin; (5) sphincter preservation and options for restoration of bowel continuity; (6) laparoscopic approaches; and (7) postoperative quality of life. © 2006 The WJG Press. All rights reserved. |
| Keywords: | cancer survival; surgical technique; survival rate; review; cancer radiotherapy; postoperative care; combined modality therapy; cancer staging; nuclear magnetic resonance imaging; positron emission tomography; recurrence risk; antineoplastic agent; neoplasm staging; laparoscopic surgery; tumor localization; quality of life; computer assisted tomography; diagnostic imaging; surgical approach; disease progression; echography; endoscopic surgery; surgery; colorectal surgery; rectal neoplasms; rectum cancer; rectum surgery; rectal cancer; perioperative care; total mesorectal excision; local surgery |
| Journal Title: | World Journal of Gastroenterology |
| Volume: | 12 |
| Issue: | 20 |
| ISSN: | 1007-9327 |
| Publisher: | Baishideng Publishing Group Inc |
| Date Published: | 2006-05-28 |
| Start Page: | 3186 |
| End Page: | 3195 |
| Language: | English |
| PUBMED: | 16718838 |
| PROVIDER: | scopus |
| PMCID: | PMC4087961 |
| DOI: | 10.3748/wjg.v12.i20.3186 |
| DOI/URL: | |
| Notes: | --- - "Cited By (since 1996): 57" - "Export Date: 4 June 2012" - "CODEN: WJGAF" - "Source: Scopus" |
Altmetric
Citation Impact
BMJ Impact Analytics
Related MSK Work