Tailored resection for persistent extramural vascular invasion in locally advanced rectal cancers.
case_series · Level IV
Where this comes from
- Record sourced from PubMed, PMID 39533156.
- Also identified by DOI 10.1111/codi.17234 and PMC identifier 11683162.
- Licence recorded as CC BY.
- The licence permits redistribution, so the abstract is shown in full and the full text is available from the publisher.
Abstract
Extramural vascular invasion (EMVI) is a bad prognostic feature in rectal cancer and cancers that remain EMVI positive after neoadjuvant therapy are at high risk for having involved circumferential resection margins. Conventional total mesorectal excision (TME) resections are inadequate in such cases and often lead to positive margins. We propose a technique for the surgical management of locally advanced tumours with persistent EMVI after neoadjuvant therapy. Ten such tumours were resected using a "beyond TME" (b-TME) approach with or without lateral pelvic lymph node dissection or seminal vesical excision. A b-TME approach, customized to the anatomy of the tumour allowed for an R0 resection with a negative circumferential resection margin (CRM) in all 10 cases. A tailored b-TME approach can achieve good results in cases at high risk for CRM involvement.