Preoperative Imaging Staging of Rectal Cancer (original) (raw)

Post-Surgical Imaging Assessment in Rectal Cancer: Normal Findings and Complications

Journal of Clinical Medicine

Rectal cancer (RC) is one of the deadliest malignancies worldwide. Surgery is the most common treatment for RC, performed in 63.2% of patients. The type of surgical approach chosen aims to achieve maximum residual function with the lowest risk of recurrence. The selection is made by a multidisciplinary team that assesses the characteristics of the patient and the tumor. Total mesorectal excision (TME), including both low anterior resection (LAR) and abdominoperineal resection (APR), is still the standard of care for RC. Radical surgery is burdened by a 31% rate of major complications (Clavien–Dindo grade 3–4), such as anastomotic leaks and a risk of a permanent stoma. In recent years, less-invasive techniques, such as local excision, have been tested. These additional procedures could mitigate the morbidity of rectal resection, while providing acceptable oncologic results. The “watch and wait” approach is not a globally accepted model of care but encouraging results on selected grou...

Rectal cancer: the impact of lymph node dissection and preoperative radiation in the era of total mesorectal excision

European Surgery-acta Chirurgica Austriaca, 2010

Zusammenfassung GRUNDLAGEN: Die Frage der adäquaten Lymphadenektomie und der richtigen Anwendung einer präoperativen Radio(chemo)therapie im Zeitalter der totalen mesorektalen Exzision (TME) wird seit vielen Jahren ohne abschließendes Ergebnis diskutiert. METHODIK: Übersichtsarbeit auf der Grundlage einer selektiven Literaturübersicht. ERGEBNISSE: Lymphknotenmetastasen (pN) sowie der Lymphknotenquotient stellen etablierte Prognosefaktoren beim Rektumkarzinom dar, so dass der Lymphadenektomie in der Rektumchirurgie eine wichtige Bedeutung zugesprochen wird.

Pre-operative imaging of rectal cancer and its impact on surgical performance and treatment outcome

European Journal of Surgical Oncology (EJSO), 2005

To discuss the ability of pre-operative MRI to have a beneficial effect on surgical performance and treatment outcome in patients with rectal cancer. A description on how MRI can be used as a tool so select patients for differentiated neoadjuvant treatment, how it can be used as an anatomical road map for the resection of locally advanced cases, and how it can serve as a tool for quality assurance of both the surgical procedure and overall patient management. As an illustration the proportion of microscopically complete resections of the period 1993-1997, when there was no routine pre-operative imaging, is compared to that of the period 1998-2002, when pre-operative MR imaging was standardized. The proportion of R0 resections increased from 92.5 to 97% (p=0.08) and the proportion of resections with a lateral tumour free margin of >1mm increased from 84.4 to 92.1% (p=0.03). The incomplete resections in the first period were mainly due to inadequate surgical management of unsuspected advanced or bulky tumours, whereas in the second period insufficient consideration was given to extensive neoadjuvant treatment when the tumour was close to or invading the mesorectal fascia on MR. There are good indications that in our setting pre-operative MR imaging, along with other improvements in rectal cancer management, had a beneficial effect on patient outcome. Audit and discussion of the incomplete resections can lead to an improved operative and perioperative management.