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Updates in Surgery
Published in: Updates in Surgery 2/2021

01-04-2021 | Rectal Cancer | Original Article

Management of the adenocarcinoma of the upper rectum: a reappraisal

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

Published in: Updates in Surgery | Issue 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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Metadata
Title
Management of the adenocarcinoma of the upper rectum: a reappraisal
Authors
George Pechlivanides
Sophia Gourtsoyianni
Nikolaos Gouvas
John Sougklakos
Evangelos Xynos
Publication date
01-04-2021
Publisher
Springer International Publishing
Published in
Updates in Surgery / Issue 2/2021
Print ISSN: 2038-131X
Electronic ISSN: 2038-3312
DOI
https://doi.org/10.1007/s13304-020-00903-6

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