Dear Dr TALSMA

May you explain more about the question?

I did not get you.

the case is a proximal rectal tumor, but the stent is far beyond that (ending on pelvic floor). Removing the stent will make a much higher anastomosis possible

can it be possible to extract the stent trans anally?If this is possible we will get a higher anastamosis.I am not quite clear about the question.

yes that is also possible, but that has the problem of traction on the tumor mucosa

removing tumor AND stent together has the advantage that you do not have to tear on the tumor mucosa

You could proceed with surgery and after getting the vascular control and adequate mobilisation,stent can be removed trans anally followed by a Betadine wash of rectum and then resect.I donot think that it causes dissemination which you are worried ,more it was an obstructed tumour to start with.

I agree with Dr Reddy's opinion. The effects on mucosa that you are worried about would happen whichever way you extract the stent. therefore it is much simpler to remove it transanally and avoid a low anastomosis.

I would however advise that for upper rectal tumor, the mesorectal resection margin should be 5 cm distal to tumor to avoid leaving behind potentially metastatic lymph nodes.

regards, raza

Thanks to you both for your answers !

Dear Doctor,

1) Rectal stent positioning represent normally a contraindication for the high rates of migration.

2) Removing distal stent can leed a cancer cells seeding

3)For this reasons I don't agree for stenting rectal tumors. If intestinal an occlusion exist, you can make a temporary colostomy for treating occlusion and eventually apply an adjuvant rectal therapy.

Regards,

Giorgio Vasquez.

Stenting should always be done under control - be it endoscopic or radiological. Once deployed, you are obliged to "treat" the stent, not the tumour after stent removal. Though low, one cannot and must not ignore the possibility of tumour cell migration and implantation on any irritated mucosa - specifically one irritated by a stent. Read Scottish data on intraluminal cancer cell downstream migration and implantation on any "raw" surface. Please remember - no " novel technique" is devoid of its share of specific complications. Plan thrice; deploy one; operate BEST I.e. ALWAYS TO BEST ONCOLOGICAL STANDARDS; which may mean changing your plan from distal anastomoses to end-stoma!!