Rectal carcinoma
| A | Anterior resection | |
| B |
Abdominal perineal resection |
|
| C |
Posterior resection |
|
| D |
Local resection |
Which of the following is considered to be the treatment of choice, in a case of rectal carcinoma at 5cm from the anal verge?
| A |
Anterior resection |
|
| B |
Abdominal perineal resection |
|
| C |
Posterior resection |
|
| D |
Local resection |
Abdomino perineal resection is indicated in the treatment of a rectal cancer in the lower rectum (0-5cm from the anal verge).
It includes removal of the rectum, anus, sphincter muscles, and a permanent colostomy is reserved most of the time for patient whose sphincter muscles are involved by tumor or for patients with rectal cancer who have poor sphincter function preoperatively.
Ideally, a surgical margin of at least 2cm should be obtained.
Recent evidence suggests that a margin as small as 1cm may be sufficient, thus allowing more sphincter-saving procedures.
It is not performed in the presence of peritoneal seeding or fixation to bony pelvis.
Ref: The MD Anderson Manual of Medical Oncology, 2nd Edition, Chapter 21; Principles and Practice of Geriatric Surgery By Ronnie Ann Rosenthal, 2nd Edition, Page 900.
A patient comes with rectal carcinoma situated 6 cm above dentate line with no nodal metastasis. Treatment of choice will be:
| A |
Anterior resection |
|
| B |
APR |
|
| C |
Radiotherapy |
|
| D |
Hartmann’s procedure |
“In this patient the tumor lies 6 cms above the dentate line (the lower limit is taken into consideration).
So the adequate margin is available for a colorectal anastomosis, hence a LAR procedure can be done”
| A | 1,2 & 4 | |
| B |
1,2 & 3 |
|
| C |
2,3 & 4 |
|
| D |
All of the above |
Adenocarcinoma is the commonest type of rectal carcinoma, just like colon carcinoma.
For a rectal carcinoma at 5cm from the anal verge the best acceptable operation is –
| A | Anterior resection | |
| B |
Abdominal perineal resection |
|
| C |
Posterior resection |
|
| D |
Local resection |
Ans. is ‘a’ i.e. Anterior resection
Dentate line is 2 cm from the anal verge, so this tumor is 3 cm above the dentate line. A sphincter saving LAR can be done.
Best procedure in mid rectal Carcinoma is –
| A |
Abdomino perinea resection |
|
| B |
Anterior resection |
|
| C |
Perineal loop |
|
| D |
Transverse Colostomy |
Ans. is ‘b’ i.e., Anterior resection
