A 77 yrs old with a good performance , adenocarcinoma of rectum 3 cm above dentate line and sessile polyp in ascending and transverse colon witch removed endoscopically with hi grade dysplasia in pathology.CT scan showed no mets in lung ,liver or para aorta. EUS in rectum T3N1.patients received neoadjuvant chemoradiotherapy and re staging CT scan showed any changes.withch surgery do you recommend?
Dear Dr Emad
thanks for your replay , you are right in normal situation but it seems to be very annoying in 77 yrs old man!
Dear Dr.Mahmoodzadeh
If the performance status is good and the patient can tolerate this procedure I recommend Total proctocolectomy
Dear Dr Babaei
Thanks for your comment, but this procedure that you mentioned is hardly tolerated at this ages mainly electrolyte imbalance.
Depends on both, assessment of the patient's physiological status and the detailed pathological assessment of the polyp, Age alone is no contra-indication for a total colectomy; similarly, if there are no other polyps, the rest of the mucosa is normal (no burnt-out IBD etc) and the patient agrees to undergo endoscopic surveillance, then resection of the rectum alone is as good an option. The decision to anastomose depends equally on local expertise and patient choice, with assessment of anal sphincter function if there is general age-related muscular atrophy, despite day-to-day "good performance". Checking functional reserve, both cardiovascular and rectal, helps in educating patients as much as clinicians with the aim of reaching better decisions. After all, our "gut instinct" (pardon the pun) would be to perform a right hemi with intensive rectal surveillance if the pathology was reversed. Of course, in some fortunate units, the availability of trans-colonic ultra-sonography assists a great deal if used pre-polypectomy, ensuring the polypectomy per say is diagnostic, but with therapeutic intent!
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