Download Early Gastrointestinal Cancers II: Rectal Cancer by Florian Otto, Manfred P. Lutz PDF

By Florian Otto, Manfred P. Lutz

This contemporary leads to melanoma learn quantity presents an up to date evaluate of the multidisciplinary administration of in the neighborhood constrained rectal melanoma in addition to colorectal melanoma with synchronous resectable liver metastases. The contents contain nearly all of the invited contributions from the second one St. Gallen EORTC Gastrointestinal melanoma convention, hung on 6-8 March 2014 in St. Gallen, Switzerland. Written by means of the various world’s top specialists within the imaging, endoscopy, pathology, molecular biology, surgical procedure, radiotherapy and scientific oncology of rectal melanoma and liver metastases, the chapters supply a complete view at the most recent techniques in analysis and multidisciplinary remedy. each clinician thinking about the care of sufferers with rectal melanoma will locate this booklet fascinating and helpful.

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1999). 44 S. L. Bosch and I. D. Nagtegaal Table 1 Grading system for quality of surgery Plane of resection TME Mesorectal fascia Intramesorectal Definition Implication Smooth CRM, no defects deeper than 5 mm, intact mesorectum Good prognosis Irregular mesorectal surface, moderate bulk to the Intermediate mesorectum prognosis Muscularis propria Defects down onto the muscularis propria, very irregular CRM APR Outside levator Poor prognosis Cylindrical specimen, with en bloc resection of levators Good prognosis Sphincter CRM on the surface of the intact sphincteric muscular tube Intermediate prognosis Intramuscular/ submucosa Perforation or missing areas of muscle Poor prognosis In case of an APR resection both gradings should be recorded 4 Quality Indicators Provided by the Pathologist: Quality of the Mesorectum The plane of surgery achieved after TME, which reflects the completeness of mesorectal excision (Table 1), is a clinically relevant prognostic factor as well as an indicator of quality of surgery (Nagtegaal et al.

It became apparent over the subsequent decade that it could play a role in the management of C. net F. Otto and M. P. 1007/978-3-319-08060-4_4, Ó Springer International Publishing Switzerland 2014 31 32 C. Cunningham early stage rectal cancer (Buess et al. 1992). However, this role remains controversial; local excision for rectal cancer is often perceived as a compromise treatment, suitable only for those unfit for radical surgery (Paty et al. 2002). Removal of the primary tumour by full thickness excision leaves occult nodal disease in situ which, in addition to the risk of tumour re-growth at the TEM site, leads to high rates of local recurrence of 20–40 % for T1-2 cancers.

2 % in the surgery alone group. 8 % in the group treated with surgery alone. The German trial CAO/ARO/ AIO-94 examined the efficacy of neoadjuvant chemoradiation versus postoperative radiation in patients undergoing TME for locally advanced (T3/T4) disease (Sauer et al. 2001, 2003). A total of 805 patients were enrolled, with 355 in the neoadjuvant group and 363 in the adjuvant group. Patients in the neoadjuvant group had significantly lower rates of local recurrence, 6 % compared to 13 % local recurrence in the adjuvant group at 5 years.

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