By Barna Bogner MD (auth.), Prof. Rudolf Schiessel MD, Univ.-Doz. Peter Metzger MD, PhD (eds.)
The paintings describes a brand new approach to sphincter salvage in surgical procedure of rectal melanoma. Low tumors of the rectum are frequently handled with amputation of the rectum. even if, this operation isn't really well-received through sufferers, because it leads to an everlasting colostomy. against this, intersphincteric resection permits sphincter salvage even in low tumors and is now greatly approved between specialists within the box of colorectal surgical procedure. The publication will describe the fundamentals (pathology,physiology, radiology) in addition to the surgical procedure and its varied modifications.
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Additional resources for Intersphincteric Resection for Low Rectal Tumors
Br J Surg 88: 1506–1512 Kayshap P, Bates N (2004) Magnetic resonance imaging anatomy of the anal canal. Australasian Radiology 48: 443–449 Intersphincteric resection: MRI for staging  Murano A, Sasaki F, Kido C, et al (1995) Endoscopic MRI using 3D-spoiled GRASS (SPGR) sequence for local staging of rectal carcinoma. J Comput Assist Tomogr 19(4): 586–591  Joosten FB, Jansen JB, Joosten HJ, Rosenbusch G (1995) Staging of rectal carcinoma using MR double surface coil, MR endorectal coil, and intrarectal ultrasound: correlation withhistopathologic ﬁndings.
Brown et al. proved in 2004 that thin section MRI performed with a pelvic phased-array coil can depict these structures essential for preoperative staging with high accuracy . Fine details of the rectal wall, mesorectum, anal sphincter and the pelvic sidewall as well as fourth order branches of the IMA and lymph nodes down to a size of 2 mm can be identiﬁed constantly. The important structures for staging are 1. 2. 3. 4. c 5. 6. the peritoneal reﬂection the urogenital septum the nerve plexuses within the pelvis the mesocolon, mesorectum, mesorectal fascia, and retroperitoneal fascia the rectal wall the pelvic ﬂoor and sphincter apparatus The peritoneal reﬂection The greatest part of the rectum is located extraperitoneally, only the anterior upper rectum is covered by a thin layer of visceral peritoneum around the front and sides down to the peritoneal reﬂection .
5 ng/dl was predictor of ypCR . An increase in CEA levels or persistence of at least 70% from baseline levels has also been suggested as a signiﬁcant predictor of worse outcome in patients with CEA levels H6 ng/ml at baseline . Also, different cutoff values have been considered for patients undergoing CRT when compared to standard colorectal cancer patients. 7 ng/ml at 4 weeks from RT completion to be a statistically signiﬁcant and independent predictor of tumor regression . Among our own series of patients undergoing, we found no correlation with both pre-treatment CEA and variation between pre and post treatment CEA levels with tumor response and oncological outcomes.