Treatment Of Distal Rectal Cancer Research Articles

Терморадиохимиотерапия в комбинированном лечении рака прямой кишки

Currently, the treatment of rectal cancer requires a multidisciplinary approach. So the combined method of treatment, including chemoradiotherapy and the surgical stage, has proven itself reliably. However, the desired results that significantly increase the rates of relapse-free and metastatic survival have not yet been achieved. The use of radio modifiers makes it possible to enhance radiation exposure without increasing the total focal dose. One of the universal radio modifiers is local hyperthermia. Purpose: To develop a method of thermoradiochemotherapy in the combined treatment of distal rectal cancer and evaluate its effectiveness. Material and methods: This work is based on the analysis of the results of treatment of 141 patients with morphologically confirmed locally advanced distal rectal cancer. In accordance with the objectives of the study, all patients were divided into 2 groups. In the combined treatment of 75 patients, the first stage was performed chemoradiotherapy (CLT) in combination with local hyperthermia (LH). Local hyperthermia was not used in the treatment of 66 patients. Results: Long-term results of complex treatment of patients with an independent course of chemoradiotherapy/thermochemoradiotherapy (dynamic observation group) and after surgical treatment are presented. One – year relapse-free survival in the group with an independent course of TRHT was 96.7 %, in the CLT group – 79.3 % (p=0.024). There was a significant increase in three–year relapse-free survival – 93.3 % versus 76.7 % in the control (p=0.041). Among patients who underwent surgical treatment at the second stage, the study of one-year relapse-free survival did not reveal statistical significance. Three – year relapse-free survival in patients with TRHT compared with the CLT group was 96.2 % versus 86.0 % (p=0.038). The effectiveness of thermoradiochemotherapy in patients of this category was evaluated. The tolerability of treatment in all patients is satisfactory. Among all radiation reactions, the most frequently observed phenomena of radiation epidermitis I–II art. in the projection of irradiation fields (Table 1). Acute radiation reactions were reversible and did not have a negative effect on the subsequent stages of treatment. Treatment for all patients (n=141) was implemented in full.

OVERVIEW OF DISCUSSIONS AND DECISION-MAKING ON TOTAL NEOADJUVANT THERAPY OF DISTAL RECTAL CANCER.

Advances implemented in thecomplex treatment of distal rectal cancer led to a decrease in thenumber of loco-regional recurrences to 5-10%, but high rates of distant metastases remain at up to 30%. They lead to disappointing long-term oncological results, which requires thesearch for improvement of each of thestages of complex treatment. As a consequence of thequestionable effectiveness of adjuvant polychemotherapy for distal rectal cancer, thequestion of thepossibility of transferring drug treatment from an adjuvant to a neoadjuvant regimen is reasonably raised. Thepresented options for full neoadjuvant therapy have been developed and tested in leading oncology centers and are based on National Comprehensive Cancer Network Version 1.2022recommendations. It is premature to make categorical conclusions regarding therecommendation of one or another variant of their implementation. Our preliminary clinical results confirmed theneed for an additional stage of restaging in thesecond option, after 16weeks of polychemotherapy before chemoradiation, in order to exclude thegeneralization of thedisease. Therefore, there is a need for a prospective, controlled intercentre study to answer some unresolved questions.

Laparoscopic extralevator abdominoperineal excision in distal rectal cancer patients: a retrospective comparative study

At present, abdominoperineal excision with neoadjuvant chemoradiotherapy (nCRT) is one of the treatment modalities of distal rectal cancer. Our study analyzed the effects of laparoscopic extralevator abdominoperineal resection (ELAPE) compared with laparoscopic conventional abdominoperineal resection(cAPR) in the treatment of distal rectal cancer. Retrospective analysis was conducted on the clinicopathological data of 177 distal rectal cancer patients treated with a laparoscopic abdominoperineal resection between 2011 and 2018. The patients were divided into four groups as follows: ELAPE without nCRT (group A), cAPR without nCRT (group B), ELAPE with long-course nCRT (group C) and cAPR with long-course nCRT (group D). Positive circumferential resection margin (CRM), local recurrence rate, 3-year disease-free survival (DFS) and 3-year overall survival (OS) did not differ between group A and group B. The rate of positive CRM in group C was lower than group D (4.4% vs. 11.9%, respectively), although the difference was not significant (P = 0.377). The 3-year local recurrence rate in group C was lower compared with group D (6.6% vs. 16.7%, respectively), although the difference was not significant (P = 0.135). Three-year DFS and 3-year OS were not different between groups C and D. This study showed that the effect of laparoscopic ELAPE in patients with low-risk rectal cancer is similar to laparoscopic cAPR, revealing that laparoscopic cAPR can be routinely selected for patients with low-risk rectal cancer. Furthermore, laparoscopic ELAPE has a tendency to reduce the rate of positive CRM and local recurrence in patients with high-risk rectal cancer. Laparoscopic ELAPE can be routinely considered for patients with high-risk rectal cancer.

STUDY OF ANORECTAL PHYSIOLOGY PRE AND POS NEOADJUVANT THERAPY FOR RECTAL CANCER BY ANORECTAL MANOMETRY AND JORGE-WEXNER SCORE.

The treatment of distal rectal cancer may be accompanied by evacuation disorders of multifactorial etiology. Neoadjuvant chemoradiotherapy (NCRT) is part of the standard treatment for patients with locally advanced extraperitoneal rectal cancer. The assessment of anorectal function after long-term NCRT in patients with cancer of the extraperitoneal rectum has been poorly evaluated. The aim of the present study was to evaluate the effects of NCRT on anorectal function and continence in patients with extraperitoneal rectal cancer. Rectal adenocarcinoma patients undergoing neoadjuvant therapy were submitted to functional evaluation by anorectal manometry and the degree of fecal incontinence using the Jorge-Wexner score, before and eight weeks after NCRT. The manometric parameters evaluated were mean resting anal pressure (ARp), maximum voluntary contraction anal pressure (MaxSp) and average voluntary contraction anal pressure (ASp). All patients underwent the same NCRT protocol based on the application of fluoropyrimidine (5-FU) at a dosage of 350 mg/m2 associated with folic acid at a dosage of 20 mg/m2, intravenously, in the first and last week of treatment, concomitantly with conformational radiotherapy with a total dose of 50.4Gy, divided into 28 daily fractions of 1.8Gy. For statistical analysis of the quantitative variables with normal distribution, the mean, standard deviation, median and interquartile range were calculated. For comparison of two related samples (before and eight weeks after NCRT), Wilcoxon's non-parametric test was used. Forty-eight patients with rectal cancer were included in the study, with a mean age of 62.8 (39-81) years, 36 (75%) of whom were male. The use of NCRT was associated with a decrease in the values of ARp (55.0 mmHg vs 39.1 mmHg, P<0.05) and ASp (161.9 mmHg vs 141.9 mmHg, P<0.05) without changing MaxSp values (185,5 mmHg vs 173 mmHg, P=0.05). There was no worsening of the incontinence score eight weeks after the use of NCRT (3.0 vs 3.3; P>0.05). NCRT was associated with a reduction in the values of ARp and the ASp. There was no change in MaxSp, as well as in the degree of fecal continence by the Jorge-Wexner score.

Quality of life in adult patients with post-surgical oncological problems to an abdominoperineal resection

Abdominoperineal Resection is a method which has been used as the gold standard for the curative treatment of distal rectal cancer. Because it is classified as a radical and invasive surgery, we have considered the importance of assessing the long-term quality of life in patients which is its best alternative, in turn the degree of psychological impact for which patients could study. Among the factors that could contribute to the performance of the procedure are: that they are in a high-advanced stage, male sex, narrow pelvis, advanced age, and the alteration of the function of the preoperative sphincter to avoid postoperative incontinence. It is important to mention that unfortunately some of these risk factors are independent of a mto the post-surgical oncological prognosis. Incontinence, genitourinary function, pain,dysfunction xual, unpleasant odor and leaks, selflimitations in social activities and even repercussions on body image, reaching depressive symptoms and varying levels of anxiety, andthese complications are what we focus on because it represents aserious problem in the quality of life of the patient undergoing abdominoperineal resection.

Assessment of Functional Outcome after Ultra-Low Anterior Resection as a Surgical Treatment of Low Rectal Carcinoma

Background: In the treatment of distal rectal cancer, abdominoperineal resection (APR) has long been the only surgical option. However, the evolution of better surgical techniques, better understanding of locoregional tumor spreading, and the introduction of preoperative chemoradiotherapy have led to more sphincter-saving surgery. Since the day of the first description of this surgical procedure, various institutions have published their experience with this technique. Objective: The objective of the study was to assess the functional outcome after ultralow anterior resection as a surgical treatment of low rectal carcinoma. Method: An observational study was conducted from April 2018 to September 2019 among 17 patients with low rectal carcinoma who underwent ultralow anterior resection with or without chemo-radiotherapy. The study was carried out in the Department of Colorectal Surgery, Bangabandhu Sheikh Mujib Medical University. Functional outcomes were measured at the 3rd, 6th, and 12th months of stoma closure by low anterior resection syndrome score, Wexner’s incontinence score, and Global health status and Functional scales of the European Organization for Treatment and Research of Cancer questionnaire. Results: LARS impact gradually decreases over time after stoma closure, from 3rd month to 6th month (p&lt;0.001) and 12th month (p&lt;0.001). The number of patients (88.2%) with Major LARS in the 3rd month decreases to 64.7% in the 6th month and 47.1% in the 12th month. A significant number of patients (41.2%) at the end of the 12th month had no LARS. The severity of incontinence also significantly decreases on follow-up (p&lt;0.05, at 6th and 12th month). 23.5% of patients in the 3rd month had severe incontinence which improved and was evident only among 5.9% in the 6th month and none in the 12th month. Significant improvement was observed both in the 6th month and 12th month compared to the 3rd month in Global Health Status (58.11±9.51, 62.12±9.71, 69.27±10.61 ........

Functional outcomes of intersphincteric resection in low rectal tumors.

Currently, sphincter-saving procedures are increasingly performed in the treatment of low rectal cancers. This study aimed to evaluate the outcomes of patients who underwent intersphincteric resection. This was a single-center, retrospective, cross-sectional study. We evaluated the electronic data files of 29 patients who had intersphincteric resections at our institute between 2008 and 2018. Bowel function outcomes were assessed prospectively using Wexner incontinence score. Histopathological, surgical and functional outcomes were analyzed. Mean age of nine female and 20 male patients included in the study was 55.8 ± 12.8 (30-76) years. A tumor-free surgical margin was achieved in all patients. Anastomotic leakage was detected in two patients. Mean Wexner incontinence score of 20 patients who still had functional anastomosis was 8.35, whereas 65% of the patients (n= 13) had a good continence status. There was no relationship between the continence status and sex, tumor distance from anal verge, T stage, distal surgical margin, and lymph node involvement. Twenty-one patients underwent primary coloanal anastomosis and eight patients underwent two-stage coloanal anastomosis. In the treatment of distal rectal cancer, adequate oncological surgery and relatively acceptable functional outcomes can be obtained with intersphincteric resection technique in suitable patients.

SELECTION OF OPTIMAL SURGERY IN THE TREATMENT OF CANCER OF THE DISTAL PARTS OF THE RECTUM

Despite the development of modern oncology, rectal cancer is a leader in morbidity andmortality. Effective treatment of rectal cancer is possible only with surgical treatment.Recently, more and more attention is paid to sphincter-preserving operations, whichallow to avoid colostomy, improving in addition to that the life quality of the patient andreturn to the usual social environment. However, after such operations, some patientshave complications, especially in the form of incontinence and feces, that significantlyaffects the life quality of patients.Carrying out a comparative analysis of the results of the surgical treatment of cancerof the distal part of the rectum after colostomy and sphincter-preserving surgery, willfacilitate the choice of optimal surgery for this oncological localization.The aim of the study - to determine the optimal colostomy or sphincter-preserving surgeryfor the treatment of the distal parts of the rectum cancer by examining the duration ofoperations, clinical features of the early postoperative period, as well as the life qualityof patients in the long terms.Material and methods. A retrospective analysis of 82 medical records of an inpatient witha diagnosis of cancer of the distal parts of the rectum, from 2017 to 2019.These medical cards, depending on the method of surgery were divided into two groups.The first group consisted of 23 people who underwent perineal extirpation of the rectumaccording to Kenyu Miles, the second group consisted of 59 patients who underwentabdominal and anal resection of the rectum with reduction of the sigmoid colon.Patients' quality of life was assessed within 1 year of surgery, during a follow-upexamination of patients, using the American Society of Colorectal Surgeons (ASCRS)questionnaire, which included the Cleveland Clinical Incontinence Scale.Statistical processing of the obtained research results was performed on a personalcomputer using Microsoft Excel spreadsheets, as well as IBM SPSS Statistics.Results. Summing up the results of the study, it should be noted that the patient's age doesnot affect the choice of surgery. The duration of abdominal-anal resection of the rectumwith reduction of the sigmoid colon is shorter and does not depend on the location of thetumor, but the duration of the early postoperative period does not differ.Excision of the excess intestine after abdominal-anal resection of the rectum with reductionof the sigmoid does not depend on the stage of the disease and is mostly performed on the12th day. The quality of the continent after sigmoid resection of the rectum improves withtime after surgery, to the end of one year term 40% of patients have good fecal retention,and the percentage of people with complete incontinence is likely decreases.Quality of life after Keny-Miles surgery improves faster, but over time, after abdominaland anal resection of the rectum with reduction of the sigmoid colon, the percentage ofpatients with mild impairment of the life quality becomes 4.3 times higher. This feature isexplained by the time required to adapt and restore the closing function of the preserved sphincter, where the quality of life directly depends on the quality of the continent.Conclusions:1. After Kenyu-Miles surgery, the quality of life of patients improves fasterthan after rectum with sigmoid reduction, but in due course (1 year), after the latter one,the number of people with mild impairment of quality of life becomes almost 2 timeshigher (p &lt;0, 01).2. In the treatment of distal rectal cancer, abdominal-anal resection of the rectum with asigmoid reduction should be preferred, but in patients with an unfavorable prognosis forlife expectancy, Kenyu-Miles surgery should be performed.

Experience in surgical correction of genital prolapse caused by abdominoperineal operations for colon cancer in anamnesis

In recent studies, it has been established that extralevator abdominoperineal extirpation (ELAPE) of the rectum can improve the oncological results of treatment of distal rectal cancer compared to standard abdominoperineal extirpation. As a result of extralevator dissection, a large defect of the perineum is formed, which requires plastic closure. While performing ELAPE, the structures that form the pelvic diaphragm are affected. This increases the risk of pelvic organ prolapse in women and significantly affects the quality of life of these patients, which requires subsequent surgical treatment. Despite the fact that pelvic organ prolapse develops as a consequence of previous surgical treatment by an oncologist, they do not consider it as a complication in the long-term postoperative period. Such patients are not referred to the operating gynecologist. Currently, this problem is poorly understood and there are no standardized approaches to the surgical treatment of pelvic prolapse in this category of patients.

Evaluation of coloanal anastomosis after resection low rectal cancer

Background: The primary goal for the surgical treatment of rectal cancer is to achieve an oncologic cure while preserving function. Intersphincteric resection and colo anal anastomosis is used to treated low rectal cancer and improve quality of life Aim of the work: This study aimed to evaluate the oncological safety of colo anal anastomosis after resection of low rectal cancer with detection of early post-operative complication. Patient and methods: This study included a total 10 patients who underwent total mesorectal excision and colo anal anastomosis attending at Damanhour Oncology Centerfrom decamber 2018 to novamber 2019. Results: Ten patients were included with adequate safety margin. Postoperative complication including anastomotic leakage (20%), fistula (20%), wound infection (30%), wound dehiscence (10%), ileus (30%). Conclusion: The Colo Anal Anastomosis technique should be considered as a safe procedure and a valuable alternative to APR in selected patients with distal rectal cancer so The inter sphincteric resection(ISR) and Colo-anal anastomosis(CAA) technique provides an opportunity to perform sphincter saving surgery in treatment of distal rectal cancer.

Low Hartmann’s procedure or intersphincteric abdominoperineal resection in the primary treatment of low rectal cancer; a survey among surgeons evaluating current practice

Background: Low Hartmann's procedure (LHP) and intersphincteric abdominoperineal resection (iAPR) are both surgical options in the treatment of distal rectal cancer when there is no intention to restore bowel continuity. This study aimed to evaluate current practice among members of the Dutch Association of Coloproctology (WCP).Methods: An online survey among members of the WCP who represent 66 Dutch hospitals was conducted. The survey consisted of 15 questions addressing indications for surgical procedures and complications.Results: Surgeons from 37 hospitals (56%) responded. Thirty-six percent does not distinguish low from high Hartmann's procedures based on estimated length of the rectal remnant. Overall, iAPR was the preferred technique in 86%. If asking whether operative approach would be different in tumours at 1 cm from the pelvic floor compared to 5 cm distance, 62% stated that they would consider a different technique. The incidence of pelvic abscess after LHP was thought to be higher, equal or lower than iAPR in 36%, 36% and 21%, respectively, with the remaining respondents not answering this question.Conclusions: The vast majority of the respondents considers iAPR as the preferred non-restorative procedure for rectal cancer not invading the sphincter complex, which contradicts with population based data from 2011.

Alternative treatment to surgery for rectal cancer

The traditional concept of rectal cancer management has changed significantly over the last few years. Although surgical resection remains central the treatment of distal rectal cancer by proctectomy and total mesorectal excision (TME), there has been increased interest in organ preservation strategies. Neoadjuvant chemoradiation (nCRT) may result in significant tumor regression and complete pathological response may be observed in up to 42% of patients. In order to avoid the morbidity, mortality and functional consequences of major surgery, selected patients with clinical and radiological evidence of significant tumor regression after nCRT have been managed non-operatively with strict follow-up (Watch & Wait Strategy—WW) with acceptable outcomes and minimal functional consequences. In addition, close surveillance may allow early detection of local recurrences and salvage alternatives with no oncological compromise.

Intersphincteric Resection Pushing the Envelope for Sphincter Preservation.

During the last 15 years, a significant evolution has emerged in the surgical treatment of rectal cancer and restoration of bowel continuity has been one of the main goals. For many years the treatment of distal rectal cancer would necessarily require an abdominoperineal resection and end colostomy. The surgical procedure of intersphincteric resection has been proposed to offer sphincter preservation in patients with low rectal cancer and has been legitimized if executed according to adequate oncologic criteria. This article will discuss the best indications, technical aspects, functional, and oncological outcomes of intersphicteric resection in the management of rectal cancer.

Laparoscopic intersphincteric resection: indications and results.

Surgical treatment of distal rectal cancer has long been based only on abdominoperineal excision, resulting in a permanent stoma and not always offering a definitive local control. Sphincter saving surgery has emerged in the last 20years and can be offered also to patients with low lying tumours, provided that the external sphincter is not involved by the disease. An intersphincteric resection (ISR) is based on the resection of the rectum with a distal dissection proceeding into the space between the internal and the external anal sphincter. Originally described as an open procedure, it has also been developed with the laparoscopic approach, and also this technically demanding procedure is inscribed among those offered to the patient by a minimally invasive surgery. Indications have to be strict and patient selection is crucial to obtain both oncological and functional optimal results. The level of distal dissection and the extent of internal sphincter resected are chosen according to the distal margin of the tumour and is based on MRI findings: accurate imaging is therefore mandatory to better define the surgical approach. We here present our actual indications for ISR, results in terms of operative time, median hospital stay for ISR in our experience and review the updated literature.

The Value of Laparoscopic Total Mesorectal Excision and Circumferential Resection Margin in the Treatment of Distal Rectal Cancer: Single Center Experience

Total mesorectal excision (TME) has emerged as a method for complete cure of rectal cancer with promising results. The present study aimed to evaluate the technical feasibility and the clinical and oncological outcomes of laparoscopic TME with abdominoperineal resection (APR) for distal rectal carcinoma. Twenty patients with distal rectal carcinoma were treated with laparoscopic APR and TME in the period of January 2012 to March 2015. Patients’ demographics, clinical symptoms, operation time, complications, pathological characteristics of the rectal tumor, and the local and distant recurrence of the tumor were recorded and analyzed. The study included 11 (55%) female and 9 (45%) male of a mean age of 46.9 ± 10.8 years. The mean distance of the tumor from the anal verge was 3.35 ± 0.9 cm. The mean operation time was 182 ± 7 minutes. Adenocarcinoma accounted for 55% of cases, whereas mucinous adenocarcinoma was detected in 40% of patients, and signet ring carcinoma in 5%. The mean circumferential resection margin (CRM) was 4.6 ±3.5 mm. The mean duration of hospital stay was 9.21± 6.9 days. Perioperative complications were recorded in seven patients (35%). Five (25%) cases were converted to open surgery. The median follow-up duration was 18 months. Local recurrence was diagnosed in two (10%) cases. Laparoscopic TME is a technically feasible procedure, yet requires adequate training and sufficient knowledge of the anatomy of the pelvis. Although all patients underwent APR and 90% of them received neoadjuvant treatment; the local recurrence was still higher than other studies which can be attributed to the pathologic characters and the stage of the tumors.

Effects of Preoperative Chemoradiotherapy on the Likelihood of Sphincter Preservation Surgery in Locally Advanced Distal Rectal Cancer: A Longitudinal Study Based on Pelvic Magnetic Resonance Imaging.

It is unclear whether preoperative chemoradiotherapy (pCRT) increases the rate of sphincter-preserving surgery (SPS), avoiding abdominoperineal resection (APR), for the treatment of distal rectal cancer. We examined whether pCRT increases the likelihood of SPS based on changes in tumor height using pelvic magnetic resonance imaging (MRI). Between January 2009 and December 2013, 105 patients underwent long-course pCRT for locally advanced distal rectal cancer (≤5 cm from the anal verge) and were included in this study. The surgical procedures were analyzed in terms of radiologic findings, including the distance from the inferior margin of tumor to the superior margin of the anorectal ring (tumor height) measured by pelvic MRI before and after pCRT. Eighty-six (81.9 %) patients underwent SPS. Overall clinical downstaging occurred in 48 (45.7 %) patients. Tumor height increased significantly after pCRT (from 15.0 ± 15.3 to 18.1 ± 16.9 mm, change 3.1 ± 9.7 mm, p = 0.01). The mean change in tumor height was not significantly different between patients who underwent SPS or APR (mean change 3.3 ± 9.6 vs. 2.3 ± 10.5 mm, p = 0.68). The mean change was significantly greater in the double-stapled anastomosis group than in the handsewn anastomosis group (mean change 5.6 ± 9.9 vs. -0.6 ± 8.6 mm, p = 0.02). This was the first MRI-based longitudinal study to show that pCRT does not appear to increase the likelihood of SPS in locally advanced distal rectal cancer, although it could improve the potential of double-stapled anastomoses.

Treatment of distal rectal cancer with preoperative intensity modulated radiation therapy (IMRT) combined with chemotherapy and transanal endoscopic microsurgery: 6-year results of 16 patients.

e14554 Background: Preoperative chemoradiotherapy is currently the standard of care for patients with distal rectal cancer. With intensity modulated radiation therapy (IMRT), more conformal doses o...

Surgical technique of robotic D3 lymph node dissection around the inferior mesenteric artery with preservation of the left colic artery and autonomic nerves for the treatment of distal rectal cancer

Our objective was to evaluate the quality of surgery regarding application of the robotic approach to perform D3 lymph node dissection over the inferior mesenteric artery (IMA) with preservation of the left colic artery (LCA) and autonomic nerves for the treatment of distal rectal cancer, which has not been reported before, although it has been successfully performed by some surgeons laparoscopically. Patients with distal rectal cancer posing risk factors for anastomotic leakage were recruited and underwent the present robotic procedure, which was standardized and presented in the attached video file. Patients' surgical outcomes were prospectively evaluated. A total of 26 patients with distal rectal cancer were operated on via the present robotic approach. The number of cleared lymph nodes was 26.1 ± 7.2 (range 10-44). The operation time was 307.3 ± 74.1 min (including docking time). The blood loss was 190.5 ± 225.8 ml. Anastomotic leakage occurred in one (1/16, 6 %) patient without preoperative chemoradiation therapy, and wound infection of port sites was detected in two (2/26, 7.6 %) patients. The patients had quick convalescence, as evaluated by the recovery of flatus passage (48.0 ± 12.0 h), hospitalization (14.6 ± 4.8 days), and degree of postoperative pain (2.5 ± 0.5, visual analog scale). The median duration for indwelling urine Foley catheter was 6.0 days (range 3.0-28). The voiding function after removal of the urine Foley catheter was good (International Prostate Score Symptom [IPSS] 0-7) in 22 (84.6 %) patients, fair (IPSS 8-14) in three (11.5 %), and poor (IPSS 15-35) in one (3.8 %). The median time of return to partial activity, full activity, and work was 2.0, 4.0, and 6.0 weeks, respectively. By using the three-armed Da Vinci(®) robotic system in our clinical setting, quality surgery of the D3 lymph node dissection around the IMA with preservation of the LCA and autonomic nerves, in which the adequacy of lymph node harvest and the security of blood supply over distal colon were juggled, can be achieved for patients with distal rectal cancer posing risk factors of anastomotic failure.

Robotic Abdominoperineal Resection for Lower Rectal Cancers: How We Do It?

Abstract Introduction: Robotic approach has been increasingly applied to the surgical resection of distal rectal cancer. All reports from the advocators on the use of robotic assistance in rectal s...

Treatment of Distal Rectal Cancer With Preoperative Intensity Modulated Radiation Therapy (IMRT) Combined With Chemotherapy and Transanal Endoscopic Microsurgery: 5 Year Results of 12 Patients

Treatment of Distal Rectal Cancer With Preoperative Intensity Modulated Radiation Therapy (IMRT) Combined With Chemotherapy and Transanal Endoscopic Microsurgery: 5 Year Results of 12 Patients