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Historical development of mesenteric anatomy provides a universally applicable anatomic paradigm for complete/total mesocolic excision

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Gastroenterology Report 2014年第4期2卷 245-250页

作者： rishabh sehgal J.Calvin Coffey Centre for Interventions in Infection Inflammation and Immunity(4i)Graduate Entry Medical SchoolUniversity of LimerickIreland Department of Surgery University Hospitals Group LimerickLimerickIreland

Although total mesorectal excision has now become the‘gold standard’for the surgical management of rectal cancer,this is not so for colon *** data,provided by Hohenberger and West et *** others,have demonstrated excellent oncological outcomes when mesenterectomy is extensive(as is implicit in the concept of a‘high tie’)and the mesenteric package not *** studies highlight the importance of understanding the basics of the mesenteric organ(including the small intestinal mesentery,mesocolon,mesosigmoid and mesorectum)and of abiding to principles of planar *** this review,we first offer classic descriptions of the mesocolon and then detail contemporary *** so doing,we provide an anatomical basis for safe and effective complete mesocolic excision(CME)in the management of colon *** we list opportunities associated with the new anatomical paradigm,demonstrating benefits across multiple *** most importantly,we feel that a crystallized view of mesenteric anatomy will overcome factors that have hindered the general uptake of CME.

关键词： mesocolon mesenteric excision complete mesocolic excision Toldt’s fascia

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Neoadjuvant radiotherapy for rectal cancer management

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World Journal of Gastroenterology 2019年第33期25卷 4850-4869页

作者： Gerard Feeney rishabh sehgal Margaret Sheehan Aisling Hogan Mark Regan Myles Joyce Michael Kerin Department of General/Colorectal Surgery Galway University HospitalGalway H91 YR71Ireland Department of Histopathology Galway University HospitalGalway H91 YR71Ireland

Thirty per cent of all colorectal tumours develop in the *** location of the rectum within the bony pelvis and its proximity to vital structures presents significant therapeutic challenges when considering neoadjuvant options and surgical *** patients with early rectal cancer can be adequately managed by surgery ***,a significant proportion of patients with rectal cancer present with locally advanced disease and will potentially benefit from down staging prior to *** therapy involves a variety of options including radiotherapy,chemotherapy used alone or in *** radiotherapy in rectal cancer has been shown to be effective in reducing tumour burden in advance of curative *** gold standard surgical rectal cancer management aims to achieve surgical removal of the tumour and all draining lymph nodes,within an intact mesorectal package,in order to minimise local *** is critically important that all rectal cancer cases are discussed at a multidisciplinary meeting represented by all relevant ***-operative staging including CT thorax,abdomen,pelvis to assess for distal disease and magnetic resonance imaging to assess local involvement is *** radiology and MDT discussion are integral in identifying patients who require neoadjuvant *** Neoadjuvant radiotherapy is potentially beneficial it may also result in morbidity and thus should be reserved for those patients who are at a high risk of local failure,which includes patients with nodal involvement,extramural venous invasion and threatened circumferential *** aim of this review is to discuss the role of neoadjuvant radiotherapy in the management of rectal cancer.

关键词： Rectal cancer Neoadjuvant therapy Low anterior resection syndrome Stoma Transanal endoscopic microsurgery Trans-anal total mesorectal excision Robotic surgery Watch and wait

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