Tailored resection for persistent extramural vascular invasion in locally advanced rectal cancers

Authors

Devesh S. Ballal, Advocate Health - Midwest
Ankit Sharma, Division of Colo-Rectal and Peritoneal Surface Oncology, Department of Surgical Oncology, Tata Memorial Hospital, Homi Bhabha National Institute, Mumbai, India.
Yogesh Bansod, Division of Colo-Rectal and Peritoneal Surface Oncology, Department of Surgical Oncology, Tata Memorial Hospital, Homi Bhabha National Institute, Mumbai, India.
Suman K. Ankathi, Department of Radiodiagnosis, Tata Memorial Hospital, Homi Bhabha National Institute, Mumbai, India.
Mufaddal Kazi, Division of Colo-Rectal and Peritoneal Surface Oncology, Department of Surgical Oncology, Tata Memorial Hospital, Homi Bhabha National Institute, Mumbai, India.
Ashwin Desouza, Division of Colo-Rectal and Peritoneal Surface Oncology, Department of Surgical Oncology, Tata Memorial Hospital, Homi Bhabha National Institute, Mumbai, India.
Avanish P. Saklani, Division of Colo-Rectal and Peritoneal Surface Oncology, Department of Surgical Oncology, Tata Memorial Hospital, Homi Bhabha National Institute, Mumbai, India.

Recommended Citation

Ballal DS, Sharma A, Bansod Y, et al. Tailored resection for persistent extramural vascular invasion in locally advanced rectal cancers. Colorectal Dis. Published online November 12, 2024. doi:10.1111/codi.17234

Affiliations

Advocate Lutheran General Hospital

Abstract

Background: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.

Methods: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.

Results: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.

Conclusion:A tailored b-TME approach can achieve good results in cases at high risk for CRM involvement.

Document Type

Article

PubMed ID

39533156