Background: Finding the appropriate treatment for advanced rectal cancer patients represents a challenge for surgeons. Determining the right diagnosis and the proper treatment requires multidisciplinary collaboration. Our aim is to present a case with advanced stage rectum cancer, who received successful multidisciplinary treatment.Material and method: A prospective multidisciplinary research is being conducted at our Department from 2018 within which patients with malignant rectal cancer are examined. Patients’ treatment is realized by the same multidisciplinary team. The patient’s preoperative investigations included MRI and a lymph node map designated by radiologists.Results: In case of a 60-year-old patient the preoperative MRI showed a stenotic formation in the middle level of the rectum that penetrated the seminal vesicle. During surgery, we found a 10x10 cm stenotic, perforated rectal cancer, which penetrated the bladder, seminal vesicle, prostate and sacrum, respectively a metastatic lesion in the livers 8th segment. During surgery R2 recto-sigmoid resection was performed with colostomy. The patient was mobilized on the first postoperative day and bowel movements were regained on the second day. The patient left the hospital on the eighth postoperative day.Conclusions: Adequate treatment of patients with advanced rectal cancer can be achieved only through multidisciplinary co-operation. Preoperative radiological examinations are mandatory. A map representing the positive colorectal lymph nodes, implemented by the radiologists, can significantly help the surgeons and pathologists.

Background: The incidence of rectum cancer is rising worldwide. New prognostic factors need to be applied to improve patients’ prognosis. The incidence of sarcopenia has been observed in various malignancies. The quantity of skeletal muscle mass is reflected in the psoas muscle index (PMI), suggesting the presence of sarcopenia. Our aim is to investigate the association of postoperative prognosis of patients with rectum cancer with the occurrence of preoperative sarcopenia with quantitative and qualitative reduction of skeletal muscle mass. Material and method: We performed a multidisciplinary research and we examined patients diagnosed with rectal cancer. The PMI was determined at the lower edge of the L3 vertebral body, using CT scan. We present our research partial results within three cases. Results: The PMI of three male patients with rectum cancer who received neoadjuvant chemoradiotherapy was: Case 1 has a PMI of 7.378 cm2/m2, the mean psoas muscle density was 50.14 UH. Case 2 has a PMI of 6,942 cm2/m2 and a mean psoas density of 43.81 UH. Case 3 has a PMI of 8.4885 cm2/m2 and an average density of 43.85 UH in the right and left psoas. Conclusions: The PMI value can be calculated with simple radiologic measurements, thus determining the diagnosis of sarcopenia. Calculations are performed using standard preoperative CT-scans. A PMI value above the threshold limit is promising in the short term, but in the long term it is not responsible for the deterioration of patients’ general condition and tumor recurrence.