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Rectal Cancer
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Educational content from recorded physician discussions — not medical advice. Always talk to your child's care team about your child's situation.
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In some healthcare systems, a community oncologist presents every single one of their rectal cancer cases to an entire board across the entire system. — Ira Leeds, Best of the Best Gen Surg - How Far is Too Far Cost-effectiveness Analysis of Regionalized Rectal Cancer Surgery - Dr. Leeds · 11:27
Best of the Best Gen Surg - How Far is Too Far Cost-effectiveness Analysis of Regionalized Rectal Cancer Surgery - Dr. Leeds
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Listen to Ira Leeds gave his presentation of "How Far is Too Far Cost-effectiveness Analysis of Regionalized Rectal Cancer Surgery" at the first ever Best of the Best in General Surgery event.
video12:26 · Sep 2022
Short-course radiation (5×5 Gy over 5 days, surgery 1–2 weeks later) is commonly used in Europe; long-course chemoradiation (40–45 Gy over 6 weeks with 6–8 week wait) is standard in the US. — Conor Delaney, Colon Cancer with Conor Delaney · 18:04
Colon Cancer with Conor Delaney
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Dr. Ponsky, professor of surgery at the Cleveland Clinic Lerner College of Medicine and Department of Surgery and Dr. Colon Delaney, chairman of digestive disease and institute and professor of surgery at Cleveland Clinic Lerner College of
podcast26:50 · Dec 2020
Surgical telementoring requires three elements: a pre-existing mentor-mentee relationship, an educational framework (not teleconsultation), and local surgical expertise to manage the disease process Surgical telementoring-emerging technologies: Comparative Technology in... · 28:40
Surgical telementoring-emerging technologies: Comparative Technology in...
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Telementoring leaders including Drs Steve Rothenberg, Shafi Ahmed, Brian Dunkin, Conor Delaney, Knut Magne Augestad, and Todd Ponsky,discuss cases using current available methods for surgicaltelementoringDuring this session, Dr. Knut Magne
video30:18 · Jan 2019
Expert statements from the recordings in this collection.
Colon Cancer with Conor Delaney
Colonoscopy is still the best test for colon cancer detection, finding the vast majority of cancers and polyps, though not perfect.
Conor Delaney1:16
Serrated adenomas (previously misclassified as hyperplastic polyps, particularly large ones in the right colon) have genetic predisposition, tie into family cancer syndromes, and carry very high cancer risk.
Conor Delaney2:05
Finding serrated adenomas requires family assessment for hereditary cancer syndromes and may necessitate changes in colonoscopy frequency and family member screening.
Serrated polyps can be flat and difficult to visualize; retroflexion in the cecum is increasingly used because they are often on the inferior or superior side of folds.
Conor Delaney3:27
For rectal cancer, distal margin requirements are 5 cm if achievable, 2 cm if necessary, and 1 cm for very low tumors as long as they are not poorly differentiated.
Conor Delaney6:13
The measurement '6 centimeters from the anal verge' varies significantly by patient body habitus and can represent different anatomical locations (anorectal ring vs. near dentate line).
Conor Delaney7:25
Distant staging for rectal cancer is best performed with CT abdomen (for liver metastases) and CT chest (replacing chest X-ray per current guidelines).
MRI has become the standard for local staging of rectal cancer, with high-resolution, high-Tesla magnets using standardized protocols developed by Bill Heald and Gina Brown at the Royal Marsden.
Conor Delaney9:50
MRI is 90 to mid-90s percent accurate for T-staging and high 80s to 90% accurate for nodal staging of rectal cancer.
Conor Delaney13:37
Endoscopic ultrasound is only about 70% accurate for predicting nodal involvement in rectal cancer and is much more operator-dependent than MRI.
Conor Delaney13:56
MRI is particularly good at distinguishing T3 and T4 tumors and assessing circumferential resection margins, though less accurate at distinguishing T1 from T2.
Conor Delaney10:27
Historical local recurrence rates for rectal cancer from good institutions were 20–38%, with some series up to 50%.
Conor Delaney10:51
With optimized surgery and imaging, local recurrence rates for rectal cancer should now be under 10%; Cleveland Clinic's rate over the last 10 years was about 3%.
Conor Delaney11:04
Circumferential resection margin is the most important margin (or many think more important than distal margin) for preventing local recurrence in rectal cancer.
Conor Delaney10:39
Total mesorectal excision (TME) can be performed with about 5 mL of blood loss because it follows a bloodless embryological plane; bleeding indicates wrong plane unless deliberately outside TME plane.
Conor Delaney12:24
Neoadjuvant therapy for rectal cancer is indicated for T3 tumors (outside the rectal wall) or node-positive disease.
Stage 1 rectal cancer (node-negative, T1 or T2), particularly in the upper third of the rectum, does not require neoadjuvant therapy.
Short-course radiation (5×5 Gy over 5 days, surgery 1–2 weeks later) is commonly used in Europe; long-course chemoradiation (40–45 Gy over 6 weeks with 6–8 week wait) is standard in the US.
25 Gy over a short period is radiotherapeutically equivalent to 40–45 Gy over a longer period, but long-course therapy may produce better tumor downstaging for bulky tumors.
Conor Delaney18:26
Transanal resection for rectal cancer is generally limited to T1 tumors less than one-third circumference and ideally less than 2 cm.
Historical local recurrence rates for transanally excised rectal cancers were about 18%, remarkably consistent across multiple centers.
Conor Delaney14:51
Transanal endoscopic microsurgery (TEM) may produce better outcomes than traditional transanal excision, though it is unclear whether this is due to technology or improved surgical understanding.
For young, curable patients, radical resection is generally favored over transanal resection; transanal resection is typically reserved for patients unfit for radical surgery or those who would require permanent stoma.
For rectal cancer, full-thickness excision is required; ESD or EMR is never appropriate for proven cancer, only for benign polyps.
Conor Delaney16:24
For colon cancer, at least 12 lymph nodes are required for adequate staging, though many surgeons aim for at least 16.
High ligation of the inferior mesenteric artery (above the takeoff of the left colic artery) is standard for sigmoid colectomy, with protection of autonomic nerves to preserve sexual function.
Conor Delaney19:59
Total mesocolic excision for colon cancer should be performed with about 5 mL of blood loss in the embryological plane between retroperitoneal peritoneum (Toldt's fascia) and mesocolic peritoneum.
Conor Delaney20:18
Scandinavian data showed local recurrence rates for colon cancer were even higher than for rectal cancer (high 20s%) before focus on complete mesocolic excision technique.
Conor Delaney20:48
For cecal or ileocecal valve tumors, 10 cm of small bowel should be resected; for mid-ascending colon tumors, 5 cm of small bowel is adequate.
Conor Delaney23:12
Extracorporeal stapled anastomosis for right hemicolectomy achieved a leak rate of 0.8% over 1000 cases at Cleveland Clinic.
Conor Delaney24:00