Clinical local staging of rectal cancer.
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Biomedical subjects
Publications and source records attributed to A Y Mason.
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Fifty-two patients with carcinoma of the rectum under-went computed tomography (CT) in the immediate preoperative period. CT was used in order to assess extrarectal tumour spread. The resected specimen was staged by the pathologist who subdivided spread in continuity beyond the bowel wall into slight, moderate or extensive. In 21 out of 23 patients with no or slight extrarectal local spread CT showed normal perirectal fat. Extrarectal spread was demonstrated by CT in eight of the nine patients found to have extensive local spread. This was seen to be circumferential in the only two patients with inoperable tumors. CT identified discrete nodal enlargement in seven of the 18 patients with histologically involved lymph nodes. CT may help the less experienced surgeon, especially when he is not confident of his findings at digital examination. CT allows assessment of high rectal tumours which cannot be examined digitally. It may play a role where a tumour with extensive local spread is clinically suspected and confirmation is needed before preoperative radiotherapy is given.
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The importance of selecting the best operation for each patient in the management of carcinoma of the rectum is emphasized. Selection must be based upon many factors, including the level of the lesion, and the mode and extent of spread. Using these important guidelines, the place of local excision, tube resection, and abdominal resection with anastomosis by the trans-sphincteric approach are discussed and the techniques described.
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