Local procedures in the management of rectal cancer

Heberer, G.; Denecke, H.; Demmel, N.; Wirsching, R.

doi:10.1007/bf01655815

Cited by 46 publications

(8 citation statements)

References 13 publications

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“…This method is generally limited to treatment of small lesions in older patients. In similar cases, European centers have reported encouraging results with the use of cryosurgery [136]. …”

Section: Treatmentmentioning

confidence: 90%

Modern Management of Rectal Cancer

Pricolo¹,

Potenti²

2001

Dig Surg

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“…This method is generally limited to treatment of small lesions in older patients. In similar cases, European centers have reported encouraging results with the use of cryosurgery [136]. …”

Section: Treatmentmentioning

confidence: 90%

Modern Management of Rectal Cancer

Pricolo¹,

Potenti²

2001

Dig Surg

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“…Two of 20 patients (10%) treated at the University of Florida experienced intermittent rectal bleeding. 70 Heberer et al 49 reported the following complications after wide local excision at the University of Munich: anastomotic leak, 7%; pneumonia, 5%; and mortality, 0%. Faivre et al 51 observed that 3 of 126 patients (2%) who underwent wide local excision required reoperation for bleeding (2 patients) or urinary retention (1 patient).…”

Section: Complicationsmentioning

confidence: 98%

Radiotherapy in the Treatment of Resectable Rectal Adenocarcinoma

Mendenhall¹,

Zlotecki²,

Snead³

et al. 2009

American Journal of Clinical Oncology

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The goal of treatment is to cure whereas maintaining sphincter function and minimizing toxicity. Although the mainstay of the treatment is surgery, radiotherapy (RT) is used in a substantial proportion of patients depending on the location and extent of the tumor. The aim of this article is to discuss the role of RT in patients with resectable rectal adenocarcinoma. This article is a review of the pertinent literature. Results show that patients with T1N0 exophytic, well to moderately differentiated, mobile tumors < or = 3 cm in diameter may be treated with either transanal excision or endocavitary RT. The probability of cure with either approach is approximately 80% to 90% and depends on selection criteria. The advantages of endocavitary RT are that it is an outpatient procedure requiring, at most, local anesthesia and is suitable for elderly, infirm patients. The disadvantage is that few of these treatment units are available. Patients who experience a local-regional recurrence may be surgically salvaged. Patients who undergo transanal excision and have unfavorable pathologic findings including equivocal or close margins, poor differentiation, invasion of the muscularis propria, and/or endothelial-lined space invasion have a high risk of local-regional recurrence after surgery alone. The addition of postoperative RT improves the likelihood of cure from 85% to 90%. Patients presenting with unfavorable tumors that are borderline resectable with a transanal excision may be downstaged with preoperative RT and rendered suitable for a wide local excision. The addition of concomitant chemotherapy probably enhances downstaging and may improve the likelihood of sphincter preservation. Patients with T3 and/or N1 rectal cancers have a relatively high probability of local-regional recurrence after surgery alone. Preoperative RT and postoperative RT combined with adjuvant chemotherapy have been shown to significantly reduce the risk of local-regional recurrence and improve survival. Whether preoperative RT alone or combined with chemotherapy is more efficacious than postoperative chemoradiation remains unclear. Endocavitary RT or transanal excision is suitable for patients with T1N0 cancers. Depending on tumor location and extent, adjuvant RT may improve the probability of local-regional control and survival for patients with locally advanced rectal adenocarcinomas.

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“…It has been reported that transanal excision can be a curative approach in early stage rectal cancer (Tl/T2), resulting in 5-year-survival rates of approximately 90%. 18,19 Preoperative treatment has been advocated in advanced rectal cancer (stages II and III) to reduce the risk of recurrence and increase the rate of sphincter-preserving operations. 20 There is evidence that preoperative radiation therapy is capable of reducing the rate of local recurrence from approximately 35% to 15%.…”

Section: Discussionmentioning

confidence: 99%

Three-Dimensional Endosonography for Staging of Rectal Cancer

Hünerbein¹,

Schlag²

1997

Annals of Surgery

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ObjectiveThis prospective study was conducted to investigate the value of three-dimensional (3D) endosonography for staging of rectal cancer. Summary Background DataTransrectal ultrasound is the most sensitive technique for preoperative staging and followup of rectal cancer. Major limitations of this technique include the complexity of image interpretation and the inability to examine stenotic tumors or to identify recurrent rectal cancer. MethodsThree-dimensional endosonography was performed in 100 patients with rectal tumors. Transrectal volume scans were obtained using a 3D multiplane transducer (7.5/10.0 MHz). Stenotic tumors were examined with a 3D fronifire transducer (5.0/7.5 MHz). The volume scans were processed and analyzed on a Combison 530 workstation (Kretztechnik, Zipf, Austria). ResultsThe 3D endosonography and conventional endosonography were performed in 49 patients with nonstenotic rectal cancer. Display of volume data in three perpendicular planes or as 3D view facilitated the interpretation of ultrasound images and enhanced the diagnostic information of the data. The accuracy of 3D endosonography in the assessment of infiltration depth was 88% compared to 82% with the conventional technique. In the determination of lymph node involvement, 3D and two-dimensional endosonography provided accuracy rates of 79% and 74%, respectively. The 3D scanning allowed the visualization of obstructing tumors using reconstructed planes in front of the transducer. Correct assessment of the infiltration depth was possible in 15 of 21 patients with obstructing tumors (accuracy, 76%). Three-dimensional endosonography displayed suspicious pararectal lesions in 30 patients. Transrectal ultrasound-guided biopsy was extremely precise (accuracy, 98%) and showed malignancy in 10 of 30 patients. Histologic analysis changed the endosonographic diagnosis in 8 (27%) of the patients. ConclusionsThe 3D endosonography permits examination of rectal cancer using previously unattainable planes and 3D views. The 3D imaging and ultrasound-guided biopsy seem capable to improve staging of rectal cancer and should be evaluated in further studies. 432

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Local procedures in the management of rectal cancer

Cited by 46 publications

References 13 publications

Modern Management of Rectal Cancer

Modern Management of Rectal Cancer

Radiotherapy in the Treatment of Resectable Rectal Adenocarcinoma

Three-Dimensional Endosonography for Staging of Rectal Cancer

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