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Extra resources for Early Gastrointestinal Cancers II: Rectal Cancer
With increasing free margins, the risk on poor outcome decreases substantially (Nagtegaal et al. 2002a), therefore it is recommended to provide adequate measurements of the CRM. The international accepted cut-off for a positive resection margin is 1 mm. 0 for local recurrence, however, after What Is ‘ Good Quality’’ in Rectal Cancer Surgery? 3. This implies that the CRM is more than a surgery quality indicator: it also defines the success of neoadjuvant therapy. In addition, CRM involvement is a powerful prognostic factor.
The surgical removal of this part of the rectum might be difficult, due to the anatomical limitations of the lower pelvis, and consequently perforations and positive margins are relatively common after this procedure. In order to judge the APR surgical technique, a modification (Nagtegaal et al. 2005) has been made to the original quality of surgery grading especially for the anal canal area (Table 1). What Is ‘ Good Quality’’ in Rectal Cancer Surgery? 6 45 Quality Indicators Provided by the Pathologist: Lymph Node Counts Lymph node sampling is an integral part of the pathological workup for resection specimens.
Organ preservation in rectal cancer is gaining considerable momentum and local excision by TEM is just one approach that can be used successfully. 2 Diagnosis and Treatment Selection in Early Rectal Cancer Locally advanced rectal cancer is diagnosed on clinical suspicion, confirmed by biopsy and staged locally by imaging, most commonly MRI. In early rectal cancer, the pathway may be quite different; malignant polyps and small sessile cancers may be diagnosed and treated simultaneously following removal by polypectomy, endoscopic mucosal resection (EMR) or endoscopic submucosal dissection (ESD).