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Adequate distal margin of resection for adenocarcinoma of the rectum

  • World Progress In Surgery
  • Published:
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Abstract

There are two questions in the surgical treatment of rectal cancer: (1) How far below a palpable rectal cancer should a surgeon cut in order to avoid cutting through cancer and, (2) Given that the surgeon has not cut through cancer, could the chance of subsequent recurrent rectal cancer have been reduced if an even greater length of bowel had been removed. For mobile tumors that are not poorly differentiated the answer to the first question is far enough in order to get a right-angled clamp on below the tumor that will not slip; the answer to the second question is no.

Résumé

Deux questions se posent: 1) à quelle distance du pôle distal d'un cancer rectal doit sectionner le chirurgien pour éviter de couper dans la tumeur? et 2) est-ce qu'une marge encore plus importante ne réduirait pas les chances de récidive? Pour les tumeurs mobiles et bien différenciées, les réponses sont 1) c'est la distance nécessaire pour placer un clamp à angle droit qui ne glisse pas, et 2) non!

Resumen

Tanto los cirujanos como sus pacientes con cáncer rectal tratan ávidamente de evitar las colostomías permanentes. Estas se hallan ciertamente indicadas cuando el esfínter anal se encuentra invadido por cáncer, y también cuando la alternativa es una anastomosis muy baja en un paciente cuyo ano no sea suificientemente fuerte para manejar la aumentada sensación de urgencia, lo cual puede resultar en incontinencia fecal incontrolable.

La recurrencia local en la pelvis después de una cirugía aparentemente curativa significa una falla catastrófica del manejo quirúrgico. Se plantean dos interrogantes pertinentes: 1) ¿ a qué distancia por debajo del cáncer rectal palpable debe seccionar el cirujano para evitar cortar a través de cáncer? 2) ¿ suponíendo que el cirujano no haya cortado a través de cáncer, se reducen las posibilidades de cáncer recurrente al no resecar una longitud mayor de recto? Para el caso de tumores que no sean del tipo pobremente diferenciado, las respuestas son: a una distancia suficiente que permita colocar seguramente una pinza de ángulo recto por debajo del tumor, y nó.

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Authors and Affiliations

  1. Consultant Surgeon, St. Mark's Hospital, City Road, EC1V 2PS, London, United Kingdom

    Robin K. S. Phillips M.B.B.S., M.S.

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  1. Robin K. S. Phillips M.B.B.S., M.S.
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Phillips, R.K.S. Adequate distal margin of resection for adenocarcinoma of the rectum. World J. Surg. 16, 463–466 (1992). https://doi.org/10.1007/BF02104448

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