TRIB1 Designers Unite!!

With advances in technology and instrumentation, tumors that are higher up can be reached with good visualization. Newer methods including TEM and TAMIS may allow access up to 15 cm in the rectum. It is important that the patient is aware that these procedures will most likely result in a perforation of the bowel above the retroperitoneum and into the peritoneal cavity which will require repair. The details of these procedures are discussed further in this review. Extended indications for LE have been reported. Currently, patients with a clinical stage ��T2 rectal adenocarcinoma should undergo radical surgery. Patients with a diagnosis of more advanced rectal cancer who are not candidates for radical surgery Angiogenesis inhibitor due to high operative risk or those who refuse to undergo radical surgery may be considered for neoadjuvant therapy followed by LE of residual disease (28). Furthermore, the use of LE in patients with early rectal cancer treated with neoadjuvant therapy has been studied in clinical trials with mixed results (29-31). Currently, there is limited data supporting LE or close observation in those patients with a complete clinical response following neoadjuvant therapy as an alternative selleck screening library to radical surgery (5,7,10). Surgical methods of local excision (LE) Transanal excision (TAE) Tumors that are less than 10 cm from the anal verge can be resected with a TAE. In preparation for surgery, a full bowel prep is prescribed, systemic antibiotics are administered, and all anticoagulant use is discontinued. Positioning in the operating room is dependent on the location of the tumor. The patient is placed in lithotomy position for posterior tumors and in prone jackknife for anterior and lateral tumors. Regional or general anesthesia can be utilized TRIB1 to remove the tumor (Table 2). To aid in visualization, the anus is gently dilated and retracted with a Lone Star? (32). The goal of TAE is a full thickness excision of the tumor down to the mesorectal fat with at least 1 cm radial/circumferential margin. In anterior tumors that abut the posterior vaginal wall, this may not be possible and a partial excision is then carried out. Good hemostasis is obtained and the defect in the bowel wall is closed in a transverse manner to avoid narrowing the lumen using interrupted absorbable sutures. The specimen should be oriented by the surgeon for pathological assessment of the margins. Postoperatively, patients experience minimal pain but fever is not uncommon. Patients can resume regular diet and activity within 24 hours (33). Postoperative complications are infrequent and include rectal bleeding which is the most common (6%), rectal stenosis (5.5%), urinary retention (1.5%), fecal incontinence (0.5%), and rectovaginal fistula (