[Problems in the treatment of upper rectal carcinoma]

In the literature there is some disagreement about the treatment of upper rectal carcinoma (aboral margin 12-16 cm from the anocutaneous line), in particular about the necessary extent of mesorectal excision and the indications for neoadjuvant and adjuvant therapy. The special pathologic features of upper rectal carcinomas (lymphatic spread, distal tumor spread beyond the gross margin) and present clinical experiences are discussed. From it result the following recommendations: partial mesorectal excision, neoadjuvant radiochemotherapy for cT4 tumors only; adjuvant radiochemotherapy in case of intraoperative tumor perforation or incision into/through tumor, incomplete partial mesorectal excision or tumor positive circumferential resection margin (CRM); adjuvant chemotherapy in case of histologically confirmed regional lymph node metastases.