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Updates in Surgery

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27.10.2020 | Original Article

Management of the adenocarcinoma of the upper rectum: a reappraisal

verfasst von: George Pechlivanides, Sophia Gourtsoyianni, Nikolaos Gouvas, John Sougklakos, Evangelos Xynos

Erschienen in: Updates in Surgery | Ausgabe 2/2021

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Abstract

The present review attempts to assess whether upper rectal cancer (URC) should be treated either as colon cancer or as rectal one, namely to be managed with upfront surgery without neo-adjuvant treatment and partial mesorectal excision (PME), or with neo-adjuvant short course radiotherapy (SCRT) or chemoradiotherapy (CRT) as indicated, followed by surgery with total mesorectal excision. Reports from current evidence including studies, reviews and various guidelines are conflicting. Main reasons for inability to reach safe conclusions are (i) the various anatomical definitions of the rectum and its upper part, (ii) the inadequate preoperative local staging,(iii) the heterogeneity of selection criteria for the neo-adjuvant treatment,(iv) the different neo-adjuvant treatment regimens, and(v) the variety in the extent of surgical resection, among the studies. Although not adequately supported, locally advanced URC can be treated with neo-adjuvant CRT provided the lesion is within the radiation field of safety, and a PME if the lower border of the tumour is located above the anterior peritoneal reflection. There is evidence that adjuvant chemotherapy is of benefit in high-risk stage II and stage III lesions.

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Titel: Management of the adenocarcinoma of the upper rectum: a reappraisal
verfasst von: George Pechlivanides
Sophia Gourtsoyianni
Nikolaos Gouvas
John Sougklakos
Evangelos Xynos
Publikationsdatum: 27.10.2020
Verlag: Springer International Publishing
Erschienen in: Updates in Surgery / Ausgabe 2/2021
Print ISSN: 2038-131X
Elektronische ISSN: 2038-3312
DOI: https://doi.org/10.1007/s13304-020-00903-6

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