How are early-stage pediatric colorectal tumors treated?

Updated: Jun 06, 2020
  • Author: Jaime Shalkow, MD, FACS; Chief Editor: Cameron K Tebbi, MD  more...
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Answer

Answer

Radical surgery is the pillar of curative treatment, including en bloc resection of adjacent organs infiltrated by the tumor. A margin of 5 cm of bowel both proximal and distal to the tumor should be removed (although this distal margin may not be feasible with a low-lying rectal tumor). Right hemicolectomy is indicated for tumors proximal to the splenic flexure, whereas left hemicolectomy is carried out for tumors of the descending colon.

Rectal cancer surgery should include total meso-rectal excision (TME) to minimize the risk of local recurrence. It also requires retrieving a minimum number of lymph nodes. The utility of this approach is still uncertain for adolescents and young adults.

Radical resection of low-lying rectal cancers has traditionally required abdominoperineal resection that involves permanent colostomy, which can have significant impact on the quality of life of adolescents and young adults. For very superficial tumors, mucosal resections might be adequate. Trans-anal TME allows for proper oncologic resection without permanent colostomy.

Indications should be made in the context of an integrated treatment strategy established by an interdisciplinary local or reference board. [67]


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