Sphincter preservation for distal rectal cancer--a goal worth achieving at all costs?

Hdl Handle:
http://hdl.handle.net/10147/207537
Title:
Sphincter preservation for distal rectal cancer--a goal worth achieving at all costs?
Authors:
Mulsow, Jurgen; Winter, Des C
Affiliation:
Institute for Clinical Outcomes Research and Education, St. Vincent's University , Hospital, Elm Park, Dublin 4, Ireland.
Citation:
World J Gastroenterol. 2011 Feb 21;17(7):855-61.
Journal:
World journal of gastroenterology : WJG
Issue Date:
1-Feb-2012
URI:
http://hdl.handle.net/10147/207537
DOI:
10.3748/wjg.v17.i7.855
PubMed ID:
21412495
Abstract:
To assess the merits of currently available treatment options in the management of patients with low rectal cancer, a review of the medical literature pertaining to the operative and non-operative management of low rectal cancer was performed, with particular emphasis on sphincter preservation, oncological outcome, functional outcome, morbidity, quality of life, and patient preference. Low anterior resection (AR) is technically feasible in an increasing proportion of patients with low rectal cancer. The cost of sphincter preservation is the risk of morbidity and poor functional outcome in a significant proportion of patients. Transanal and endoscopic surgery are attractive options in selected patients that can provide satisfactory oncological outcomes while avoiding the morbidity and functional sequelae of open total mesorectal excision. In complete responders to neo-adjuvant chemoradiotherapy, a non-operative approach may prove to be an option. Abdominoperineal excision (APE) imposes a permanent stoma and is associated with significant incidence of perineal morbidity but avoids the risk of poor functional outcome following AR. Quality of life following AR and APE is comparable. Given the choice, most patients will choose AR over APE, however patients following APE positively appraise this option. In striving toward sphincter preservation the challenge is not only to achieve the best possible oncological outcome, but also to ensure that patients with low rectal cancer have realistic and accurate expectations of their treatment choice so that the best possible overall outcome can be obtained by each individual.
Language:
eng
MeSH:
Anal Canal/*physiology/surgery; Colorectal Surgery/*methods; Humans; Patient Preference; Quality of Life; Rectal Neoplasms/*surgery; Treatment Outcome
ISSN:
1007-9327 (Print); 1007-9327 (Linking)

Full metadata record

DC FieldValue Language
dc.contributor.authorMulsow, Jurgenen_GB
dc.contributor.authorWinter, Des Cen_GB
dc.date.accessioned2012-02-01T10:30:39Z-
dc.date.available2012-02-01T10:30:39Z-
dc.date.issued2012-02-01T10:30:39Z-
dc.identifier.citationWorld J Gastroenterol. 2011 Feb 21;17(7):855-61.en_GB
dc.identifier.issn1007-9327 (Print)en_GB
dc.identifier.issn1007-9327 (Linking)en_GB
dc.identifier.pmid21412495en_GB
dc.identifier.doi10.3748/wjg.v17.i7.855en_GB
dc.identifier.urihttp://hdl.handle.net/10147/207537-
dc.description.abstractTo assess the merits of currently available treatment options in the management of patients with low rectal cancer, a review of the medical literature pertaining to the operative and non-operative management of low rectal cancer was performed, with particular emphasis on sphincter preservation, oncological outcome, functional outcome, morbidity, quality of life, and patient preference. Low anterior resection (AR) is technically feasible in an increasing proportion of patients with low rectal cancer. The cost of sphincter preservation is the risk of morbidity and poor functional outcome in a significant proportion of patients. Transanal and endoscopic surgery are attractive options in selected patients that can provide satisfactory oncological outcomes while avoiding the morbidity and functional sequelae of open total mesorectal excision. In complete responders to neo-adjuvant chemoradiotherapy, a non-operative approach may prove to be an option. Abdominoperineal excision (APE) imposes a permanent stoma and is associated with significant incidence of perineal morbidity but avoids the risk of poor functional outcome following AR. Quality of life following AR and APE is comparable. Given the choice, most patients will choose AR over APE, however patients following APE positively appraise this option. In striving toward sphincter preservation the challenge is not only to achieve the best possible oncological outcome, but also to ensure that patients with low rectal cancer have realistic and accurate expectations of their treatment choice so that the best possible overall outcome can be obtained by each individual.en_GB
dc.language.isoengen_GB
dc.subject.meshAnal Canal/*physiology/surgeryen_GB
dc.subject.meshColorectal Surgery/*methodsen_GB
dc.subject.meshHumansen_GB
dc.subject.meshPatient Preferenceen_GB
dc.subject.meshQuality of Lifeen_GB
dc.subject.meshRectal Neoplasms/*surgeryen_GB
dc.subject.meshTreatment Outcomeen_GB
dc.titleSphincter preservation for distal rectal cancer--a goal worth achieving at all costs?en_GB
dc.contributor.departmentInstitute for Clinical Outcomes Research and Education, St. Vincent's University , Hospital, Elm Park, Dublin 4, Ireland.en_GB
dc.identifier.journalWorld journal of gastroenterology : WJGen_GB
dc.description.provinceLeinster-

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