Total mesorectal excision is not necessary for cancers of the upper rectum

López-Köstner, Francisco; Lavery, Ian C.; Hool, Graham R.; Rybicki, Lisa; Fazio, Victor W.

doi:10.1067/msy.1998.91361

Cited by 226 publications

(145 citation statements)

References 24 publications

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“…However, elements related to characterization of the rectal lesion were less commonly described, suggesting a focus for a rectal cancer quality improvement initiative. For example, the height of the tumour in the rectum as seen endoscopically can often be important in determining the need for a total compared with a subtotal mesorectal excision ("high rectal cancer") 15 and also may affect decisions concerning the use of adjuvant radiotherapy, particularly for high rectal cancers 16 .…”

Section: Discussionmentioning

confidence: 99%

Clinical Information Available to Oncologists in Surgically Treated Rectal Cancer: Room to Improve

Porter

Urquhart²,

Rheaume

et al. 2013

Current Oncology

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Section: Discussionmentioning

confidence: 99%

Clinical Information Available to Oncologists in Surgically Treated Rectal Cancer: Room to Improve

Porter

Urquhart²,

Rheaume

et al. 2013

Current Oncology

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“…There are some reports that ordinary PME for upper rectal cancer can provide good local control [6, 7]. However, to conduct appropriate mesorectal excision at an adequate distance from the tumor in the narrow pelvic cavity is not always easy [4, 5, 9].…”

Section: Discussionmentioning

confidence: 99%

A New Technique to Achieve Sufficient Mesorectal Excision in Upper Rectal Cancer

Ohigashi¹,

Hayashi²,

Shimada³

et al. 2007

Dig Surg

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Background: Appropriate partial mesorectal excision (PME) is extremely important for prevention of local recurrence even in upper rectal cancer. However, it is not always easy to conduct PME in the narrow pelvic cavity. We devised a new surgical technique that involves a rectal transection followed by PME. Methods: After rectal mobilization in the layer targeted for total mesorectal excision, only the rectal wall was bluntly dissected at an appropriate distance from the tumor. Initial transection of the rectum allows drawing the rectum toward the anal side so that the mesorectum can be confirmed with a good visual field. Excision of the mesorectum was easy, and it could be resected in a short time. Results: This technique was conducted on seven patients with upper rectal cancer and on four patients with rectosigmoid cancer. Separation of the rectal wall was comparatively easy, and we had no incidence of wall injury. The average distance from the rectal stump to the distal mesorectum in the freshly resected specimen was 15 mm, indicating satisfactory PME. Conclusions:This easily performed method is a promising procedure for achieving sufficient PME in upper rectal cancer.

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“…The technical approach in these tumours is a dissection 5 cm below the tumour at the level of the mesorectal excision. This technique has been shown to result in local tumour control comparable to that of carcinomas of the sigmoid colon [14]. Aside from the meticulous sharp dissection of the mesorectum, other technical issues should be taken into consideration.…”

Section: Standard Oncological Resection: Complete Tumour Treatment Ormentioning

confidence: 99%

Significance of Surgery in the Multimodality Treatment of Rectal Cancer

Willeke

Gerstenbergk-Helldorf²

2002

Oncol Res Treat

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Since the NIH recommendations in 1990 the majority of patients with rectal cancer are treated by a multimodality approach. The last decade has seen considerable improvements in the overall management of rectal cancer, therefore a certain reorientation seems justified. Although many questions remain to be answered, some general recommendations for the treatment of rectal cancer focussed on the small pelvis can be given. Surgery with total mesorectal excision is the standard therapy for cancers of the middle and low rectum in stages T1/2 N0. Adjuvant radiochemotherapy and shortterm pre-operative radiotherapy are both feasible approaches for the treatment of stage II and stage III rectal carcinomas. The superiority of either concept awaits clarifying randomised trials. Patients with T4 rectal cancers should undergo long-term neoadjuvant radiochemotherapy with consecutive oncological resection. The exact mode of the neoadjuvant regimen combining high remission rates with low treatment-associated morbidity needs further refinements. Local excision should be restricted to patients with well-differentiated, less than semi-circumferential T1 carcinomas. Tumours with less favourable histologies should not be treated locally unless general patient conditions forbid oncological resections. In these instances, additional radiochemotherapy appears able to reduce the risk of local recurrence.

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Total mesorectal excision is not necessary for cancers of the upper rectum

Cited by 226 publications

References 24 publications

Clinical Information Available to Oncologists in Surgically Treated Rectal Cancer: Room to Improve

Clinical Information Available to Oncologists in Surgically Treated Rectal Cancer: Room to Improve

A New Technique to Achieve Sufficient Mesorectal Excision in Upper Rectal Cancer

Significance of Surgery in the Multimodality Treatment of Rectal Cancer

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