Aims and objectives
The discrimination between intra- and extraperitoneal rectal cancer has important implications for both oncologic and surgical grounds,
since these different tumors have to be treated in different ways and since they present different risks of local recurrence and different prognosis : tumors located above the peritoneal reflection have to be considered as colon cancers,
since they share the same clinical course,
while locally advanced (>T3a or N+) extraperitoneal rectal tumors take advantage of combined chemoradiation preferentially administered before surgery (i.e.
neoadjuvant chemoradiation) [2,
Methods and materials
Inclusion of patients
This was a retrospective,
institutional review board approved study.
Patients were included by performing a search in our single-institution radiology database looking for patients with a recent diagnosis of rectal carcinoma (any T and N stage) scheduled for surgery (i.e.
anterior resection or total mesorectal excision – TME –),
with or without neoadjuvant therapy,
between January 2012 and December 2013.
In this time interval,
we included all patients who both underwent thin-section rectal MRI for local tumor staging and contrast-enhanced CT...
38 patients were included: 24 (63%) men and 14 (37%) women with a mean age of 68.8±9.4 years (range: 55-83 years).
Mean height and weight of male patients were 172.2±9.8 cm and 73.6±8.8 kg,
and mean BMI was 23.8±3.3.
Mean height and weight of female patients were 164.3±9.2 cm and 64.1±9.7 kg,
and mean BMI was 24.0±2.9.
2 patients had a stage I (T1/2,
M0) rectal cancer,
7 patients had a stage II (T3 or T4,
M0) rectal cancer,...
Recent studies have already discussed how the position of rectal tumors with respect to the APR has important treatment implications,
since extra- and intra-peritoneal cancers present different systemic spread [1,
13]: as a consequence,
an accurate preoperative identification of the APR may address extra-peritoneal tumors to neoadjuvant therapy ,
since choosing the optimal treatment for each patient is crucial in relation to the risk of under- or overtreatment.
Rigid rectoscopy may provide a measurement of the distance from the inferior edge of tumors...
Multidisciplinary treatment of rectal cancer: medical oncology.
van Krieken JH,
van de Velde CJ; Dutch Colorectal Cancer Group.
Preoperative radiotherapy combined with total mesorectal excision for resectable rectal cancer.
N Engl J Med.
Chemoradiotherapy for rectal cancer—when,
and how? N Engl J Med.