What are the ASCRS guidelines on surgery for rectal cancer?

Updated: Apr 06, 2021
  • Author: Burt Cagir, MD, FACS; Chief Editor: N Joseph Espat, MD, MS, FACS  more...
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The American Society of Colon and Rectal Surgeons (ASCRS) defines rectal cancer as cancer located within 15 cm of the anal verge by rigid proctoscopy. ASCRS 2013 revised management guidelines and practice parameters recommend that patients with low-risk, early-stage rectal cancer be treated with primary surgical therapy. Treatment of locally advanced or high-risk disease should include neoadjuvant radiation or chemoradiation followed by surgery. [100]

Additional recommendations include the following [100] :

  • Local excision for T1 tumors absent high risk factors
  • Total mesorectal excision (TME) for curative resection of tumors of the middle and lower thirds of the rectum
  • In the absence of clinical involvement, extended lateral lymph node dissection (LLND) is not necessary in addition to TME
  • For tumors of the upper third of the rectum, a tumor-specific mesorectal excision should be used.
  • For T4 rectal cancers, resection of involved adjacent organs should be performed with an en bloc technique.
  • Oophorectomy is advised for grossly abnormal ovaries or contiguous extension of a rectal cancer, but routine prophylactic oophorectomy is not necessary
  • Laparoscopic TME has comparable outcomes with open TME

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