TY  - CHAP
M1  - Book, Section
TI  - Local Excision for Stage I Rectal Cancer
A1  - Lynn, Patricio Bernardo
A1  - Widmar, Maria
A1  - Garcia-Aguilar, Julio
A2  - Morita, Shane Y.
A2  - Balch, Charles M.
A2  - Klimberg, V. Suzanne
A2  - Pawlik, Timothy M.
A2  - Posner, Mitchell C.
A2  - Tanabe, Kenneth K.
PY  - 2018
T2  - Textbook of Complex General Surgical Oncology
AB  - Total  mesorectal  excision  (TME)  remains  the  gold  standard  in  the  treatment  of  patients  with  early-stage  rectal  cancer.  The  reported  oncological  outcomes  of  this  approach  for  stage  I  disease  are  excellent,  with  local  recurrence  (LR)  rates  of  3%,  and  5-year  survival  as  high  as  93%.1  But  TME  is  a  major  operation  associated  with  some  mortality  and  significant  morbidity.  More  than  one  in  three  patients  develop  perioperative  complications.2  Anastomotic  leak  with  low  rectal  anastomosis  occurs  in  approximately  10%  of  patients,  and  has  been  associated  with  poor  oncological  outcomes.3,4  Injuries  to  the  hypogastric  and  pelvic  nerves  can  cause  genitourinary  dysfunction  in  up  to  40%  of  patients5;  functional  disturbances  such  as  tenesmus,  bowel  urgency,  soiling,  and  fecal  incontinence  are  also  common.6  To  prevent  the  consequences  of  anastomotic  leak,  many  patients  are  given  a  temporary  diverting  loop  ileostomy,  which  is  inconvenient  and  adds  to  the  burden  of  morbidity.7  In  addition,  between  20%  and  30%  of  all  rectal  cancers—and  a  higher  proportion  of  patients  with  distal  rectal  cancers—require  an  abdominoperineal  excision  (APE)  of  the  rectum  with  a  permanent  colostomy,  a  procedure  that  significantly  impacts  patients’  quality  of  life.5  
SN  - 
PB  - McGraw-Hill Education
CY  - New York, NY
Y2  - 2024/04/19
UR  - accesssurgery.mhmedical.com/content.aspx?aid=1145762422
ER  -