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Critical and Challenging Issues in the Surgical Management of Low-Lying Rectal Cancer

 Aeris Jane D. Nacion  ;  Youn Young Park  ;  Seung Yoon Yang  ;  Nam Kyu Kim 
 YONSEI MEDICAL JOURNAL, Vol.59(6) : 703-716, 2018 
Journal Title
Issue Date
Abdomen/pathology ; Adult ; Aged ; Chemoradiotherapy ; Digestive System Surgical Procedures/methods* ; Female ; Humans ; Lymphatic Metastasis/pathology ; Male ; Middle Aged ; Neoadjuvant Therapy ; Quality of Life ; Rectal Neoplasms/pathology ; Rectal Neoplasms/surgery* ; Rectum/surgery*
Low rectal cancer ; rectal neoplasm ; surgical management
Despite innovative advancements, the management of distally located rectal cancer (RC) remains a formidable endeavor. The critical location of the tumor predisposes it to a circumferential resection margin that tends to involve the sphincters and surrounding organs, pelvic lymph node metastasis, and anastomotic complications. In this regard, colorectal surgeons should be aware of issues beyond the performance of total mesorectal excision (TME). For decades, abdominoperineal resection had been the standard of care for low-lying RC; however, its association with high rates of tumor recurrence, tumor perforation, and poorer survival has stimulated the development of novel surgical techniques and modifications, such as extralevator abdominoperineal excision. Similarly, difficult dissections and poor visualization, especially in obese patients with low-lying tumors, have led to the development of transanal TME or the "bottom-to-up" approach. Additionally, while neoadjuvant chemoradiotherapy has allowed for the execution of more sphincter-saving procedures without oncologic compromise, functional outcomes remain an issue. Nevertheless, neoadjuvant treatment can lead to significant tumor regression and complete pathological response, permitting the utilization of organ-preserving strategies. At present, an East and West dualism pervades the management of lateral lymph node metastasis, thereby calling for a more global and united approach. Moreover, with the increasing importance of quality of life, a tailored, individualized treatment approach is of utmost importance when taking into account oncologic and anticipated functional outcomes.
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1. College of Medicine (의과대학) > Dept. of Surgery (외과학교실) > 1. Journal Papers
Yonsei Authors
Kim, Nam Kyu(김남규) ORCID logo https://orcid.org/0000-0003-0639-5632
Yang, Seung Yoon(양승윤) ORCID logo https://orcid.org/0000-0001-8129-7712
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