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Proximal protective stoma by low anterior resection of the rectum - When? How? How long?

M. Radionov, J. Blagov, DD Ziya, S. Kovachev, I. Setchanov, T. Pojarliev

Abstract

There is an evolution in the diagnostic algorithm of rectal cancer. In this condition preoperative investigations assist in deciding the optimal treatment. The relation of the tumor edge to the circumferential margin (CRM) is an important factor in deciding the need for neoadjuvant treatment and determines the prognosis. Those with threatened or involved margins are offered long course chemoradiation to enable R0 surgical resection. Endoanal ultrasound (EUS) is useful for tumor (T) staging; hence EUS is a useful imaging modality for early rectal cancer. Magnetic resonance imaging (MRI) is useful for assessing the mesorectum and the mesorectal

fascia which has useful prognostic significance and for early identification of local recurrence. Computerized tomography (CT) of the chest, abdomen and pelvis is used to rule out distant metastasis. Identification of the malignant nodes using EUS, CT and MRI is based on the size, morphology and internal characteristics but has drawbacks. Most of the common imaging techniques are suboptimal for imaging following chemoradiation as they struggle to differentiate fibrotic changes and tumor. In this situation, EUS and MRI may provide complementary information to decide further treatment. Functional imaging using positron emission tomography (PET) is useful, particularly PET/CT fusion scans to identify areas of the functionally hotspots. In the current state, imaging has enabled the multidisciplinary team of surgeons, oncologists, radiologists and pathologists to decide on the patient centered management of rectal cancer. Functional imaging may play an active role in identifying patients with lymph node metastasis and those with residual and recurrent disease following neoadjuvant chemoradiotherapy in near future.


Keywords

stoma; rectum; protective stoma; anterior resection

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DOI: http://dx.doi.org/10.14748/ssm.v43i5.1194

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About The Authors

M. Radionov
General and endoscopic surgery clinic, University hospital St. Anna
Bulgaria

J. Blagov
General and endoscopic surgery clinic, University hospital St. Anna
Bulgaria

DD Ziya
General and endoscopic surgery clinic, University hospital St. Anna Sofia
Bulgaria

S. Kovachev
General and endoscopic surgery clinic, University hospital St. Anna Sofia
Bulgaria

I. Setchanov
General and endoscopic surgery clinic, University hospital Saint Anna Sofia
Bulgaria

T. Pojarliev
General and endoscopic surgery clinic, University hospital St. Anna of Sofia
Bulgaria

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