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How Can Extended Demolition in Primary Advanced Presentations Be Beneficial?

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Multidisciplinary Management of Rectal Cancer

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Abstract

Approximately 5–15% of rectal cancers are diagnosed in a “locally advanced” stage [1], with invasion of neighboring organs and structures (clinical T4a, a neoplasm that perforates the visceral peritoneum; T4b, a tumor that invades other organs or structures directly); from the surgeon’s point of view, a tumor may be called locally advanced (or unresectable) when it is impossible to resect it radically following the natural visceral fascial layer, as advocated in total mesorectal excision surgery. Not rarely, despite their large size, these tumors have no evidence of distant dissemination, and so they are potentially curable, especially if regional lymph nodes are free of metastasis, as is surprisingly common [2–4]. Anyway, these lesions are challenging to treat, because of the invasion of surrounding tissues: anteriorly the bladder, prostate, seminal vesicles, uterus, adnexia, and vagina; laterally the pelvic sidewall, iliac vessels, ureters, and nerve bundles; posteriorly the sacrum and coccyx.

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Authors and Affiliations

  1. Department of Surgical Sciences – Digestive Surgery Division, Catholic University – School of Medicine, Largo A. Gemelli, 8, 00168, Rome, Italy

    Giovanni Battista Doglietto MD & Antonio Pio Tortorelli PhD

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  1. Giovanni Battista Doglietto MD
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  2. Antonio Pio Tortorelli PhD
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Correspondence to Antonio Pio Tortorelli PhD .

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Editors and Affiliations

  1. Dept. of Radiation Oncology, Università Cattolica S Cuore, Rome, Italy

    Vincenzo Valentini

  2. Head, Div. Clinical Oncology Research, University Clinic Halle (Saale), Martin-Luther-University Halle-Wittenberg, Halle, Sachsen-Anhalt, Germany

    Hans-Joachim Schmoll

  3. Department of Surgery, Leiden Univ Med Ctr, Leiden, The Netherlands

    Cornelis J. H. van de Velde

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Doglietto, G.B., Tortorelli, A.P. (2018). How Can Extended Demolition in Primary Advanced Presentations Be Beneficial?. In: Valentini, V., Schmoll, HJ., van de Velde, C. (eds) Multidisciplinary Management of Rectal Cancer. Springer, Cham. https://doi.org/10.1007/978-3-319-43217-5_51

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  • DOI: https://doi.org/10.1007/978-3-319-43217-5_51

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