Tailored resection for persistent extramural vascular invasion in locally advanced rectal cancers.

IF 2.9 3区医学 Q2 GASTROENTEROLOGY & HEPATOLOGY

Colorectal Disease Pub Date : 2024-11-12 DOI:10.1111/codi.17234

Devesh S Ballal, Ankit Sharma, Yogesh Bansod, Suman K Ankathi, Mufaddal Kazi, Ashwin Desouza, Avanish P Saklani

引用次数: 0

Abstract

Background: Extramural vascular invasion (EMVI) is a bad prognostic feature in rectal cancer and cancers that remain EMVI positive after neoadjuvant therapy are at high risk for having involved circumferential resection margins. Conventional total mesorectal excision (TME) resections are inadequate in such cases and often lead to positive margins.

Methods: We propose a technique for the surgical management of locally advanced tumours with persistent EMVI after neoadjuvant therapy. Ten such tumours were resected using a "beyond TME" (b-TME) approach with or without lateral pelvic lymph node dissection or seminal vesical excision.

Results: A b-TME approach, customized to the anatomy of the tumour allowed for an R0 resection with a negative circumferential resection margin (CRM) in all 10 cases.

Conclusion: A tailored b-TME approach can achieve good results in cases at high risk for CRM involvement.

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针对局部晚期直肠癌持续性壁外血管侵犯的定制切除术。

背景：壁外血管侵犯（EMVI）是直肠癌的一个不良预后特征，新辅助治疗后仍为EMVI阳性的癌症极有可能出现周缘切除边缘受累的情况。传统的全直肠系膜切除术（TME）在此类病例中效果不佳，往往会导致切除边缘阳性：方法：我们提出了一种对新辅助治疗后仍存在EMVI的局部晚期肿瘤进行手术治疗的技术。我们采用 "超越TME"（b-TME）方法切除了10个此类肿瘤，同时进行或不进行盆腔侧淋巴结清扫或精囊切除：结果：根据肿瘤解剖结构定制的b-TME方法在所有10个病例中都实现了R0切除，周缘切除边缘（CRM）为阴性：结论：对于CRM受累风险较高的病例，量身定制的b-TME方法可取得良好效果。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Colorectal Disease 医学-胃肠肝病学

CiteScore

6.10

自引率

11.80%

发文量

406

审稿时长

1.5 months

期刊介绍： Diseases of the colon and rectum are common and offer a number of exciting challenges. Clinical, diagnostic and basic science research is expanding rapidly. There is increasing demand from purchasers of health care and patients for clinicians to keep abreast of the latest research and developments, and to translate these into routine practice. Technological advances in diagnosis, surgical technique, new pharmaceuticals, molecular genetics and other basic sciences have transformed many aspects of how these diseases are managed. Such progress will accelerate. Colorectal Disease offers a real benefit to subscribers and authors. It is first and foremost a vehicle for publishing original research relating to the demanding, rapidly expanding field of colorectal diseases. Essential for surgeons, pathologists, oncologists, gastroenterologists and health professionals caring for patients with a disease of the lower GI tract, Colorectal Disease furthers education and inter-professional development by including regular review articles and discussions of current controversies. Note that the journal does not usually accept paediatric surgical papers.