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Robot-assisted Total Mesorectal Excision and Lateral Pelvic Lymph Node Dissection for Locally Advanced Middle-low Rectal Cancer
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Locally advanced rectal cancer: management challenges.
R F Kokelaar1, M D Evans1, M Davies1
1Department of Colorectal Surgery, Singleton Hospital, Swansea, UK.
Oncotargets and Therapy
|October 28, 2016
Summary
Locally advanced rectal cancer (LARC) and recurrent rectal cancer require complete surgical resection for best outcomes. Innovative surgical techniques are emerging for previously inoperable tumors involving complex pelvic anatomy.
Area of Science:
- Surgical Oncology
- Rectal Cancer Management
Background:
- 5-10% of rectal cancer patients have locally advanced disease (LARC).
- 10% of rectal cancers recur post-surgery, with half being locoregional.
- Complete (R0) resection is key for long-term outcomes in LARC and recurrent rectal cancer.
Approach:
- Multimodal staging is crucial for assessing operability of advanced rectal tumors.
- Neoadjuvant therapies can enhance resectability.
- Surgical options are limited for tumors involving the lateral pelvic sidewall or high sacrum due to technical challenges and high morbidity.
Key Points:
- Achieving histological clearance is difficult in complex pelvic resections.
- Patients with tumors involving challenging anatomy are often treated palliatively with poor survival.
- Pioneering centers are developing novel techniques for extensive resections, including en bloc and composite procedures.
Conclusions:
- New techniques for 'beyond-total mesorectal excision' tumors offer potential for radical treatment of previously inoperable cases.
- These advanced surgical approaches, despite limited experience, aim to improve outcomes for challenging rectal cancer cases.
- This review highlights management challenges and evolving surgical strategies for LARC.
