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Tumour Cells in Peri‐Tumoural Fibrosis after Neoadjuvant Treatment in Locally Advanced Rectal Cancer
Author(s) -
Tanaka S.,
Palmer G.,
Martling A.,
Lindholm J.,
Holm T.
Publication year - 2006
Publication title -
colorectal disease
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.029
H-Index - 89
eISSN - 1463-1318
pISSN - 1462-8910
DOI - 10.1111/j.1463-1318.2006.01082_5.x
Subject(s) - medicine , fibrosis , colorectal cancer , neoadjuvant therapy , radiation therapy , total mesorectal excision , cancer , chemotherapy , immunohistochemistry , pathology , radiology , surgery , breast cancer
Objective In patients with locally advanced (T4) rectal cancer extended resections are usually performed to achieve R0 resection. A significant downsizing and downstaging is often seen after neoadjuvant treatment and histopathological assessment may reveal a T0–T3 tumour with fibrosis between the tumour and the adjacent resected structure. Provided this fibrosis does not contain tumour cells, a less extensive, organ preserving, resection would be preferable in such patients. The aim of this study was to assess the presence of tumour cells within the peri‐tumoural fibrosis Method A total of 53 patients with locally advanced (T4) rectal cancer according to clinical and/or radiological evaluation were treated with preoperative radiotherapy or radio‐chemotherapy. Extensive surgery, including resection of another structure or organ was performed based on the pretreatment assessment. Histopathological examination was performed using routine staining supplemented by immunohistochemistry (CK 20). Results Scattered tumour cells within the fibrosis, at or outside the mesorectal fascia, were found in 26 patients and in the remaining patients no tumour cells were found. Conclusion Although neoadjuvant treatment often induces fibrosis and downsizes locally advanced rectal cancer, less extensive resections (i.e. TME alone) cannot be advocated since the peri‐tumoural fibrosis contains tumour cells in 50% of the patients.