Zmienna lokalizacja gruczolakoraka odbytnicy: wpływ opisu badania na wybór zabiegu operacyjnego

Surgery is an irreplaceable and fundamental component of the combined treatment of patients with adenocarcinoma of the of the rectum. Depending on the location of the tumor, it can take the form of anterior rectal resection (AR, or anterior resection), allowing for sphincter-sparing of the rectum and maintain the continuity of the gastrointestinal tract) or abdomino-sacral rectal amputation (ASAR, or abdomino-sacral amputation). abdomino-sacral amputation of rectum), which involves excision of the rectum with the tumor along with the rectum and the emergence of a permanent single-barreled fecal fistula [1]. In many centers abdominoperineal rectal amputation is still performed (APR, abdomino-peroineal amputation), despite its the lesser oncologic radicality and higher rate of complications of this procedure [2]. In some cases, a Hartmann's procedure, which involves resection (and therefore excision of part) of the intestine occupied by the tumor and the emergence of a permanent single-barrel fecal fistula.

Doubts about the distance of the tumor from the rectum in a man suffering from rectal cancer caused a the occurrence of a problem in choosing the optimal surgical method and increased emotional stress in the patient. The reason for the discrepancy was the morphological form of the stalked and displaced in the lumen of the organ of the tumor. Doubts were clarified by performing additional tests (Rigid rectoscopic speculum and intraoperative per rectum examination)

The atypical morphological form of the tumor may be the reason for performing a mutilating procedure, unnecessary in cases similar to the one described. The decision on the type of surgery should be made by the operator based on the verified findings. The location of rectal lesions should be verified by per rectum examination in each case. In case of discrepancies, it is worth consider performing an examination with a rigid rectoscope.