Abstract
Wide dissection of adenocarcinoma of the rectum is difficult because of the fixed structure of the anatomic pelvis. The role of lateral margins, excision of the mesorectum, and extended lymphadenectomy have recently received much attention in the literature in dealing surgically with more advanced rectal carcinomas. The basic question to be resolved in the future is whether additional radical surgery is of more benefit than adjuvant chemoradiation therapy in this setting.
Résumé
Faire une résection large d'un cancer du rectum est difficile en raison des structure fixes de la cavité pelvienne. On a beaucoup insisté récemment sur l'importance de la résection large (latérale), l'excision du mésorectum, et la lymphadénectomie dans les cancers du rectum avancés. La question de base est de savoir si la chirurgie radicale est plus bénéfique que la chimiothérapie dans cette circonstance.
Resumen
La recurrencia local después de resección quirúrgica por adenocarcinoma del recto continúa siendo un problema difícil que encaran los cirujanos. Se ha establecido que hasta la mitad de los pacientes sometidos a resección rectal por cáncer avanzado del recto desarrolla recurrencia local. A diferencia de lo que ocurre con el más móvil colon abdominal, las resecciones amplias de carcinomas ubicados por debajo de la reflexión peritoneal son difíciles debido al confinamiento que presenta la pelvis anatómica. La influencia de los márgenes laterales de la resección, de la resección del mesorecto y de la linfadenectomía amplia han recibido mucha atención en la literatura reciente sobre el manejo quirúrgico de los carcinomas rectales en estado avanzado. El interrogante básico para resolver en el futuro es si en tales circunstancias la cirugía más radical es de mayor beneficio que la terapia adyuvante de quimiorradiación.
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Wolff, B.G. Lateral margins of resection in adenocarcinoma of the rectum. World J. Surg. 16, 467–469 (1992). https://doi.org/10.1007/BF02104449
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DOI: https://doi.org/10.1007/BF02104449