Treatment Of Rectal Adenocarcinoma Research Articles

Racial comparisons in treatment of rectal adenocarcinoma and survival in the military health system.

Racial disparities in treatment and outcomes of rectal cancer have been attributed to patients' differential access to care. We aimed to study treatment and outcomes of rectal cancer in the equal access Military Health System (MHS) to better understand potential racial disparities. We accessed the MilCanEpi database to study a cohort of patients aged 18 and older who were diagnosed with rectal adenocarcinoma between 1998 and 2014. Receipt of guideline recommended treatment per tumor stage, cancer recurrence, and all-cause death were compared between non-Hispanic White and Black patients using multivariable regression models with associations expressed as odds (AORs) or hazard ratios (AHRs) and their 95% confidence intervals (CIs). The study included 171 Black and 845 White patients with rectal adenocarcinoma. Overall, there were no differences in receipt of guideline concordant treatment (AOR = 0.76, 95% CI = 0.45 to 1.29), recurrence (AHR = 1.34, 95% CI = 0.85 to 2.12), or survival (AHR = 1.08, 95% CI = 0.77 to 1.54) for Black patients compared with White patients. However, Black patients younger than 50 years of age at diagnosis (AOR = 0.34, 95% CI = 0.13 to 0.90) or with stage III or IV tumors (AOR = 0.28, 95% CI = 0.12 to 0.64) were less likely to receive guideline recommended treatment than White patients in stratified analysis. In the equal access MHS, although there were no overall racial disparities in rectal cancer treatment or clinical outcomes between Black and White patients, disparities among those with early-onset or late-stage rectal cancers were noted. This suggests that factors other than access to care may play a role in the observed disparities and warrants further research.

RECTAL ADENOCARCINOMA: CLINICAL EVALUATION AND TREATMENT THROUGH ROBOTIC SURGERY

Rectal adenocarcinoma is a malignant neoplasm that develops in the glandular cells of the rectum. Its clinical evaluation and treatment have been objects of considerable interest, especially with the advancement of robotic surgery. The introduction of the robot in colorectal surgery has provided significant advantages, such as better visualization, precision and control of movements, resulting in potential benefits for patients. However, the literature on the effectiveness and outcomes of robotic surgery in the treatment of rectal adenocarcinoma is vast and varied. Objective: to examine and synthesize the available evidence on the clinical assessment and treatment of rectal adenocarcinoma using robotic surgery, focusing on the last 10 years. Methodology: The methodology followed the PRISMA checklist guidelines. We used the PubMed, Scielo and Web of Science databases to identify relevant articles published in the last 10 years. The descriptors used were "rectal adenocarcinoma", "robotic surgery", "clinical evaluation", "treatment" and "results". The inclusion criteria were studies that evaluated robotic surgery in the treatment of rectal adenocarcinoma, published in English or Portuguese. The exclusion criteria were studies unrelated to the topic, studies without access to the full text and studies with duplicate data. Results: The results revealed an increasing trend in the use of robotic surgery for the treatment of rectal adenocarcinoma. Key topics covered included oncological outcomes, postoperative complications, post-treatment quality of life, and comparisons with other surgical approaches. Conclusion: The review highlights the growing evidence supporting the efficacy and safety of robotic surgery in the treatment of rectal adenocarcinoma. However, additional studies are needed to further understand its clinical utility and its long-term impact on patient outcomes.

Total neoadjuvant therapy for rectal cancer in the rural community oncology setting.

41 Background: The treatment of localized rectal adenocarcinomas with Total Neoadjuvant Therapy (TNT) has become the national standard. Data on the efficacy of TNT in a predominantly rural community oncology setting is limited. Methods: This ongoing retrospective analysis included 94 patients with proficient MMR Stage II or III rectal adenocarcinoma treated with traditional neoadjuvant treatment of chemoradiation followed by surgical resection +/- adjuvant chemotherapy, or Consolidation (chemoradiation upfront) TNT versus Induction (chemotherapy upfront) TNT followed by surgical resection, diagnosed between 2017 and 2022 and treated at the Avera Cancer Institute in Sioux Falls, South Dakota. The primary objectives were to compare the pathologic response and treatment completion rates in patients with rectal cancer treated with TNT to patients treated with traditional neoadjuvant treatment. The secondary objective was to compare the pathologic response rate for TNT at different tumor locations. Results: Of 94 patients assessed, 54 patients received traditional neoadjuvant treatment and 40 patients received TNT. For patients treated with traditional neoadjuvant treatment, 43% (n=23) completed all recommended treatment, with 63% (n=34) achieving a partial response (PR) and 19% (n=10) a complete pathologic response (CR). For patients treated with TNT, 93% (n=37) completed all recommended treatment, and 68% (n=27) achieved a PR and 15% (n=6) achieved a CR. For patients that received Consolidation TNT (n=21), 66% (n=12) achieved a PR and 21% (n=4) achieved a CR. For patients that received Induction TNT (n=19), 68% (n=13) achieved a PR and 11% (n=2) achieved a CR. For patients with high tumor location (n=4) treated with TNT, 50% (n=2) achieved a PR and one patient achieved a CR (25%). For patients with mid tumor location (n=18) treated with TNT, 67% (n=12) achieved a PR and 22% (n=4) achieved a CR. For patients with low tumor location (n=18) treated with TNT, 72% (n=13) achieved a PR and one patient (6%) achieved a CR. Conclusions: The treatment of rectal adenocarcinoma with TNT in the rural community cancer center setting is achievable with a higher completion rate compared to traditional neoadjuvant treatment. Our results also show a trend toward a higher complete pathologic response rate in Consolidation compared to Induction approach and in high/mid rectal tumors compared to low rectal tumors. Future work will be conducted to assess for any differences in recurrence and survival.

Retossigmoidectomia com anastomose colorretal e nefrectomia devidos a pólipos adenomatosos, adenocarcinoma retal e carcinoma de células renais em paciente pós-COVID-19

Objetivo: Dissertar sobre um caso de paciente senil, com câncer colorretal, múltiplos pólipos adenomatosos, tumor renal e COVID-19. Analisar as terapêuticas propostas e a relevância da retossigmoidectomia e nefrectomia como tratamento ao adenocarcinoma retal e carcinoma renal. Detalhamento do caso: Paciente, masculino, 82 anos, admitido em 2019 com crises álgicas abdominais, equimose extensa em membro superior direito, petéquia em lábio inferior, calafrios, diaforese, hematúria e melena. À colonoscopia observou-se lesão retal vegetante, pólipos e diverticulose em cólon. Em junho de 2020 evoluiu com dispneia, febre, fraqueza e mal estar generalizado, confirmando COVID-19 em exames laboratoriais, evoluindo com cura 2 semanas após tratamento. Em agosto de 2020, em nova colonoscopia, observou-se diversos pólipos sésseis e lesão polipoide de 5cm em reto. À biópsia, indicado adenocarcinoma retal. À tomografia computadorizada de abdome e à ecografia de abdome total foi identificado tumor renal à direita. Paciente foi então submetido a retossigmoidectomia com anastomose colorretal e nefrectomia à direita. Considerações finais: A colonoscopia ainda é considerada um exame de rastreio excelente para os pólipos intestinais. Com relação ao adenocarcinoma retal, a retossigmoidectomia é considerada um tratamento curativo eficaz. Contudo, a COVID-19 é considerada um fator de risco com alta mortalidade em pacientes com câncer.

Expression levels of hnRNPK and p21WAF1/CIP1 are associated with resistance to radiochemotherapy independent ofp53 pathway activation in rectal adenocarcinoma.

Ionizing radiation (IR) is frequently applied in the treatment of rectal adenocarcinoma, however, there is marked variance in the response to radiochemotherapy between individual tumors. In our previous investigations, it was shown that the overexpression of heterogeneous nuclear ribonucleoprotein K (hnRNP K) confers radioresistance to malignant melanoma and colorectal carcinoma (CRC) in vitro, however, the underlying mechanism remains to be elucidated. As hnRNP K, a p53 binding partner and cofactor for the transcriptional activation of p53 target genes, is overexpressed in CRC, the present study investigated the possible radioprotective effect of the hnRNP K/p53-induced upregulation of p21 (also known as WAF1/CIP1) in rectal adenocarcinoma. Immunohistochemistry was performed for hnRNP K, p53 and p21 in a series of 68 consecutive cases of rectal adenocarcinoma with full molecular characterization following radiochemo-therapy and 14 corresponding pre-therapeutic biopsies, and the results were correlated with clinicopathological characteristics and the percentage of vital tumor cells following therapy. In addition, pathway analyses, protein immunoprecipitation, western immunoblotting and immunofluorescence microscopy were performed to identify dysregulated kinase signaling and hnRNP K targets upon exposure of CRC cells to IR. Although the fraction of vital tumor cells upon neoadjuvant therapy was significantly higher in hnRNP K/p21-positive tumors (P=0.0047 and P=0.0223, Students’ t-test), no significant association was found between the protein expression levels of hnRNP K, p53 and p21 (P>0.05, χ2 test). Irradiation enhanced apoptotic pathway activation via p53/CHK2 phosphorylation and poly (ADP-ribose) polymerase cleavage, and induced the overexpression and interaction of hnRNP K and p53. However, p53 Ser15-phosphorylation was independent of the presence of hnRNP K, and there was no measurable effect of hnRNP K on the expression of p21 in vitro. Taken together, the results of the present study support a radioprotective role for hnRNP K, which may be mediated through an interaction with p53, however, this effect appears to be independent of the hnRNP K/p53-induced upregulation of p21 in rectal adenocarcinoma.

Pathologic response following treatment for locally advanced rectal cancer: Does location matter?

BackgroundDespite advances in the treatment of rectal adenocarcinoma, the management of locally advanced disease remains a challenge. The standard of care for patients with stages II and III rectal cancer includes neoadjuvant chemoradiation followed by total mesorectal excision and postoperative chemotherapy. Much effort has been dedicated to the identification of predictive factors associated with pathologic complete response (pCR). The aim of our study was to examine our institutional experience and determine whether any association exists between anatomic tumor location and the rate of pCR. We hypothesized that lesions more than 6 cm from the anal verge are more likely to achieve a pCR. MethodsUsing data from our prospectively maintained tumor registry, a query was completed to identify all patients with locally advanced rectal adenocarcinoma who underwent treatment at Fox Chase Cancer Center from 2002 to 2015. Demographics, pretreatment, posttreatment, and final pathologic TNM staging data were collected as well as treatment intervals in days, recurrence status, overall survival, and disease-free survival. Patients with incomplete endoscopic data, staging information, survival, or recurrence status were excluded. The primary outcome measured was the degree of pathologic response. Logistic regression was used to adjust for covariates. ResultsOf the 135 patients eligible in the study cohort, 39% were female and 61% were male. Regarding initial clinical stage, 43% were stage II and 57% were stage III. A total of 29% had a pCR, 43% had partial pathologic response, and 28% had no response to neoadjuvant treatment. Tumor location ranged from 0 to 13 cm from the anal verge. Longitudinal tumor length was recorded in 111 patients, facilitating the calculation of mean tumor distance from the anal verge. This ranged from 0 to 15.5 cm. Univariate and multivariable analyses were completed using pCR as a primary outcome. No statistically significant difference was noted based on tumor location, regardless of measurement approach. ConclusionsAnatomic location of cancer of the rectum does not affect pCR after neoadjuvant therapy and subsequent surgical resection.

WATCH AND WAIT APPROACH IN RECTAL CANCER TREATMENT

Introduction: The colorectal carcinoma is the most common gastrointestinal neoplasm worldwide and in Bulgaria. Often the choice of surgical treatment is difficult, and organ-preserving surgery is not feasible. In borderline situations when choosing a surgical approach is difficult, a neoadjuvant chemoradiotherapy may downstage the disease and provide better results and more surgical options. If the treatment response is partial or complete, the possibility of carrying out sphincter-sparing surgery is increased. The aim of the study is to present a clinical case of a patient with rectal carcinoma, submitted to multimodal treatment. Case report: The presented patient is a 65-year old female with alarming symptoms and diagnosed rectal adenocarcinoma. The patient underwent preoperative neoadjuvant treatment. After a full course of treatment, the patient was restaged and reported a complete clinical response to therapy. After recommended period, she underwent an anterior resection of the rectum. This case is an example of the potential possibilities of a multidisciplinary team in surgical oncology. Conclusions: There are certain criteria, regarding the waiting approach in rectal carcinoma, and it subjected to a set of indications in case of a complete response to the treatment. The current case is an excellent example of performing a sphincter-spearing surgery, which may lead to higher quality of life for the target patient group. The ESMO guidelines for neoadjuvant treatment of rectal adenocarcinoma are applicable in Bulgaria.

Preliminary Results From a Phase I Trial of Radiation Therapy, Capecitabine, and the Phosphatidylserine-Targeting Antibody Bavituximab in the Neoadjuvant Treatment of Rectal Adenocarcinoma

Preliminary Results From a Phase I Trial of Radiation Therapy, Capecitabine, and the Phosphatidylserine-Targeting Antibody Bavituximab in the Neoadjuvant Treatment of Rectal Adenocarcinoma

Optimal timing of surgical resection after radiation therapy in locally advanced rectal adenocarcinoma: An analysis of the National Cancer Database (NCDB).

510 Background: In treatment of rectal adenocarcinoma, an increased time delay (TD) of 6-12 weeks from the end of radiation therapy to surgery may increase the rate of complete pathologic response (pCR), but the optimal TD with respect to survival has not been established. This study evaluates the impact of TD on overall mortality. Methods: The NCDB was queried for patients with adenocarcinoma of the rectum and no evidence of metastasis at diagnosis, who underwent preoperative chemoradiation followed by radical surgical resection. Standard statistical methods were employed for descriptive statistics and Cox model development. Results: The study included 6805 patients, predominantly Caucasian (87.2%) and males (63.9%) who generally were treated with low anterior resection (57.3%), colonanal reanastomosis (8.4%), or abdominoperineal resection (28.4%), and had median survival of 66.6 months. The effects of age, surgical margins (-/+), comorbidity index, time to discharge after surgery, TMN pathologic staging, surgical volume, and patient income significantly impacted mortality after radiation and surgery (p<0.05 for all values). There was a significant relationship between TD and pCR (p=.0002). At TD less than 30 days, 4.0% of patients achieved pCR, while 9.3% of patients have achieved pCR by 75 days. In TD of greater than 75 days, the rate of pCR decreased. Overall, 6.8% of patients (n=461) achieved pCR. Using a refined cox model, a TD of more than 60 days was associated with 20% greater risk of mortality (95% CI 1.068 – 1.367). This effect became more pronounced with increasing TD; a TD of greater than 75 days was associated with 28% (95% CI 1.06-1.55) increased risk of mortality, while patients with TD less than 60 days saw a survival benefit. Conclusions: Though an interval up to 75 days between radiation and surgery may achieve higher rates of complete pathologic response, delay of more than 60 days from radiation to surgical resection and subsequent systemic chemotherapy decreases overall survival in patients with rectal cancer.

The combination of neoadjuvant chemoradiotherapy and epidermal growth factor receptor inhibitors in the treatment of rectal adenocarcinoma

Rectal adenocarcinoma, in contrast to colorectal carcinoma, is typical of its high local reccurence rate. Radiotherapy is proved to reduce the incidence of recurrences. Neoadjuvant chemoradiotherapy demonstrated better treatment results than adjuvant chemoradiotherapy. Standard cytotoxic agents involved in combination therapy are 5- flurouracil or capecitabin. Epidermal growth factor receptor (EGFR) is supposed to play an important role in cell- cycle regulation, proliferation, differentiation, and surviving of normal epithelial tissues. EGFR overexpression in patients with rectal adenocarcinoma is associated with radioresistance of malignant tissues, lower rates of patological complete response after neoadjuvant chemoradiation and generally poor survival. There are many clinical studies describing combination of neoadjuvant chemoradiotherapy with EGFR inhibitors, however, this regimen has not gained an acceptance as a standard of treatmentment.

Chronic myeloid leukemia following the treatment of rectal adenocarcinoma

Solid tumors may occur in 3% of the patients with chronic myeloid leukemia (CML). Philadelphia (Ph)-positive CML was diagnosed in a 66-year-old man upon a white blood cell count of 58.1 x 10(9)/L. He had no symptoms and physical findings 3 years after treatment for rectal adenocarcinoma. Imatinib mesylate 400 mg/day was started and white blood cell count was lowered to 5.7 x 10(9)/L in 1 month. The patient had received several chemotherapeutic agents such as 5-fluorouracil, irinotecan, raltitrexed, capecitabine, and oxaliplatin. In the literature, there are two reports on CML after the treatment of colorectal carcinoma. The possibility of a relationship between oxaliplatin and/or irinotecan and CML may not be fully excluded. In conclusion, hematological disorders such as CML may emerge in colorectal carcinoma and whole blood counts should be carefully checked. The possibility of a relationship between CML and the chemotherapeutic agents in colorectal carcinoma should be further evaluated.

Endorectal ultrasound-directed biopsy: a useful technique to detect local recurrence of rectal cancer

This study assesses the value of endorectal ultrasound (ERUS)-directed biopsy in detecting local recurrence of rectal cancer. We reviewed the records of patients undergoing ERUS by a single surgeon for surveillance after treatment of rectal adenocarcinoma. Lesions suggestive of local recurrence underwent ERUS-assisted core-needle biopsy (EAB) via a proctoscope after precise ERUS localization or direct ERUS-guided biopsy (EGB) via a B&K Medical probe. From 1991 to 2003, 525 patients underwent 2,490 surveillance ERUS. Of these patients, 51 underwent 62 biopsy sessions: 36 EGB and 26 EAB. The mean age of patients was 67.2 years (range 38-93 years); 22 (43%) were female. Only 11 patients (22%) had undergone prior radical resection of their primary tumor. No patient experienced a complication from the biopsies despite five being anticoagulated. Of 39 patients whose cancer recurrence was documented during follow-up, 32 (82%) were diagnosed at the initial biopsy session, and in five (13%), recurrence was detected only with ERUS. The combined sensitivity, specificity, and accuracy of EAB and EGB in detecting recurrence was 83, 100, and 87%, respectively. In 26 patients with local recurrence, resection was performed with curative intent. ERUS with biopsy is useful in detecting local recurrence after treatment of rectal cancer. It is safe, with a high diagnostic yield. It may be particularly useful in patients at higher risk for local recurrence (i.e., after endocavitary radiation and local excision) and may allow early detection of local recurrence, thereby permitting attempts at curative resection.

Should 'doughnut' histology be routinely performed following anterior resection for rectal cancer?

Stapled low anterior resection is widely employed in the treatment of rectal adenocarcinoma. The technique yields two tissue 'doughnuts' which are often submitted for histological examination. This process is labour intensive and not part of the minimum data set for colorectal cancer histopathology reports. A consecutive series of anterior resection doughnuts from 125 patients was reviewed retrospectively to assess the impact of doughnut pathology on the management of patients. Four doughnuts had a histological abnormality reported but none of these altered treatment. Routine histological examination of 'doughnuts' is not beneficial to the management of patients undergoing surgery for rectal adenocarcinoma.

Treatment of rectal adenocarcinoma with endocavitary and external beam radiotherapy: results for 199 patients with localized tumors

Purpose: Endocavitary radiation (RT) provides a conservative alternative to proctectomy. Although most suitable for small, mobile lesions, patients with less favorable tumors are often referred if they are poor surgical candidates. Knowing the extent to which radiation can control such tumors can be an important factor in making clinical decisions.Methods and Materials: One hundred ninety-nine patients, who received endocavitary RT with or without external beam RT (EBRT) during 1981 through 1995, were followed for disease status for a median of 70 months, including deaths from intercurrent causes. In the early years of the study, 21 patients were treated with endocavitary RT alone, the remainder of the patients received pelvic EBRT (usually 45 Gy in 25 fractions) 5–7 weeks before endocavitary RT.Results: Overall, 141 patients (71%) had local control with RT alone. Salvage surgery rendered an additional 20 patients disease free, for an ultimate local control rate of 81%. On multivariate analysis for local control (excluding surgical salvage), the most significant factors were mobility to palpation, use of EBRT, and whether pretreatment debulking of all macroscopic disease had been done (generally a piecemeal, nontransmural procedure). Of 77 cases staged by transrectal ultrasonography, the local control rate with RT alone was 100% for uT1 lesions, 85% (90% with no evidence of disease after salvage) for freely mobile uT2 lesions, and 56% (67% with no evidence of disease after salvage) for uT3 lesions and uT2 lesions that were not freely mobile.Conclusions: Patients with small mobile tumors that are either uT1 or have only a scar after debulking achieve excellent local control with endocavitary RT. About 15% of mobile uT2 tumors fail RT; therefore, careful follow-up is critical. Small uT3 tumors are appropriate for this treatment only if substantial contraindications to proctectomy are present.

Insulin-like growth factor I receptor antagonism augments response to chemoradiation therapy in colon cancer cells.

Colorectal cancer remains one of the most prevalent malignancies in the United States. Improvement in local disease control is seen when 5-fluorouracil (5-FU) is used in combination with pelvic irradiation for rectal adenocarcinoma. The frequent overexpression of insulin-like growth factor I receptor (IGF-I-R) in rectal adenocarcinoma suggests that inhibition of the signal transduction pathway may be a novel approach to enhance tumor response. This investigation seeks to define the role of IGF-I-R antagonism, using monoclonal antibody alpha-IR3, in augmenting cytotoxicity to adjuvant chemoradiation therapy for adenocarcinoma of the rectum. SW 480 colon cancer cells were cultured to semiconfluent conditions with dose titrations performed for 5-FU to determine that the IC(50) (inhibitory concentration of 50% of the cells) was 0.5 microg/ml. The IC(50) for 5-FU was reassessed in the presence of IGF-I. Experimental groups included colon cancer cells combined with 5-FU; 6-MeV external beam radiation (100-500 cGy); and alpha-IR-3. The addition of 100 ng/ml IGF-I 1 h prior to 5-FU or radiation significantly blunted the expected cytotoxicity, resulting in a 10-fold increase in the IC(50) (from 0.5 to 5 microg/ml). Receptor antagonism using the monoclonal antibody alpha-IR-3 (100-400 ng/ml) produced a dose-dependent increase in cytotoxicity compared with 5-FU alone. The addition of radiation produced synergistic amplification of this response. IGF-I-R activation blocks the expected cytotoxic effects of 5-FU and external beam radiation. Receptor antagonism increased the cytotoxic response of chemoradiation therapy. These data suggest the utility of inhibiting IGF-I-R signal transduction in the treatment of rectal adenocarcinoma.

Conservative treatment of rectal adenocarcinoma with endocavitary irradiation or wide local excision and postoperative irradiation.

To evaluate the role of endocavitary irradiation and wide local excision followed by irradiation in the treatment of early-stage rectal adenocarcinoma. Sixty-five patients with early-stage adenocarcinoma of the rectum were treated with endocavitary irradiation (n = 20) or wide local excision followed by external-beam irradiation (n = 45) between 1974 and 1994 at the University of Florida. All patients were monitored for a minimum of 2 years or until death. The rates of local-regional control at 5 years were 80% after endocavitary irradiation and 86% after wide local excision and radiotherapy. The ultimate 5-year local-regional control rates were 85% and 92%, respectively. Multivariate analysis of local-regional control with sphincter preservation showed that tumor configuration (exophytic v ulcerative) significantly influenced this end point; local-regional control was decreased in patients with ulcerated cancers. Five-year cause-specific survival rates were 84% after endocavitary irradiation and 88% after wide local excision and radiotherapy. Multivariate analysis revealed that tumor configuration significantly influenced cause-specific survival; patients with ulcerated tumors had a worse prognosis. Endocavitary irradiation is a highly effective treatment for properly selected patients with early-stage rectal adenocarcinoma. Patients with less favorable lesions that appear to be limited to the muscularis propria have a high chance of cure with sphincter preservation after wide local excision and external-beam irradiation.

Aggressive versus conventional strategies in the treatment of rectal adenocarcinoma

Comparison of an aggressive approach (including total mesorectal excision and combined modality adjuvant therapy) with a conventional approach in the treatment of primary rectal cancer. Retrospective study. Memorial Sloan-Kettering Cancer Centre, New York (MSKCC) and University Hospital Leiden, the Netherlands (UHL). One hundred and sixty-nine patients treated at MSKCC and 96 patients treated at UHL. Total mesorectal excision (MSKCC) and conventional resection (UHL). Overall survival and local recurrence-free survival. Five-year overall survival was 73% for MSKCC patients and 52% for UHL patients (P < 0.001). Five-year local recurrence-free survival was 83% for MSKCC patients and 72% for UHL patients (P=0.001). Relative risk of dying or developing a local recurrence was 3.37 and 2.61, respectively, for patients treated at UHL compared to patients treated at MSKCC (P<0.001 and P=0.008, respectively). These data suggest that an aggressive approach including total mesorectal excision and combined modality adjuvant therapy improves survival and local control compared to a conventional approach.

Modern surgical treatment for rectal adenocarcinoma: How often is a permanent stoma necessary?

Modern surgical treatment for rectal adenocarcinoma: How often is a permanent stoma necessary?