Pathological outcomes in rectal cancer following laparoscopic surgery

Pathological outcomes in rectal cancer following laparoscopic surgery 1INTRODUCTIONMultiple systematic reviews and meta‐analyses of randomized trials comparing laparoscopic and open rectal cancer resections have shown similar short‐ and long‐term outcomes between the two procedures. There remains a dearth of information, however, with respect to the role laparoscopic surgery plays in the routine surgical management of rectal cancer, particularly with respect to its ability to provide a safe pathological surgical outcome.The description of the perirectal fascia by Thomas Jonnesco has contributed significantly to the understanding of the surgical anatomy of the rectum, as has the work of Mike and Kano regarding laparoscopic anatomy. These contributions, together with the promotion of total mesorectal excision (TME) of the rectum by R.J. Heald, explain why rectal resection is regarded as a highly “specimen‐orientated” procedure. The identification of the correct anatomical plane to mobilize the extraperitoneal rectum with preservation of the perirectal fascia, avoiding injury to strategic neurovascular structures and ensuring adequate circumferential resection margin (CRM), produces a unique operative specimen. A detailed examination of the specimen by the pathologist provides not only important prognostic information but also may be used to evaluate the quality of surgery according to the key criteria of integrity of the perirectal fascial envelope, CRM clearance, lymph http://www.deepdyve.com/assets/images/DeepDyve-Logo-lg.png Asia-Pacific Journal of Clinical Oncology Wiley

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Publisher
Wiley Subscription Services, Inc., A Wiley Company
Copyright
Copyright © 2018 John Wiley & Sons Australia, Ltd
ISSN
1743-7555
eISSN
1743-7563
D.O.I.
10.1111/ajco.12781
Publisher site
See Article on Publisher Site

Abstract

1INTRODUCTIONMultiple systematic reviews and meta‐analyses of randomized trials comparing laparoscopic and open rectal cancer resections have shown similar short‐ and long‐term outcomes between the two procedures. There remains a dearth of information, however, with respect to the role laparoscopic surgery plays in the routine surgical management of rectal cancer, particularly with respect to its ability to provide a safe pathological surgical outcome.The description of the perirectal fascia by Thomas Jonnesco has contributed significantly to the understanding of the surgical anatomy of the rectum, as has the work of Mike and Kano regarding laparoscopic anatomy. These contributions, together with the promotion of total mesorectal excision (TME) of the rectum by R.J. Heald, explain why rectal resection is regarded as a highly “specimen‐orientated” procedure. The identification of the correct anatomical plane to mobilize the extraperitoneal rectum with preservation of the perirectal fascia, avoiding injury to strategic neurovascular structures and ensuring adequate circumferential resection margin (CRM), produces a unique operative specimen. A detailed examination of the specimen by the pathologist provides not only important prognostic information but also may be used to evaluate the quality of surgery according to the key criteria of integrity of the perirectal fascial envelope, CRM clearance, lymph

Journal

Asia-Pacific Journal of Clinical OncologyWiley

Published: Jan 1, 2018

Keywords: ; ; ;

References

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