How Can Extended Demolition in Primary Advanced Presentations Be Beneficial?

  • Giovanni Battista Doglietto
  • Antonio Pio Tortorelli


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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Copyright information

© Springer-Verlag Berlin Heidelberg 2018

Authors and Affiliations

  • Giovanni Battista Doglietto
    • 1
  • Antonio Pio Tortorelli
    • 1
  1. 1.Department of Surgical Sciences – Digestive Surgery DivisionCatholic University – School of MedicineRomeItaly

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