RT Book, Section
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.
SR Print(0)
ID 1145762422
T1 Local Excision for Stage I Rectal Cancer
T2 Textbook of Complex General Surgical Oncology
YR 2018
FD 2018
PB McGraw-Hill Education
PP New York, NY
SN 9780071793315
LK accesssurgery.mhmedical.com/content.aspx?aid=1145762422
RD 2024/04/24
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