What is the surgical management for a rectal mass?

From the Guidelines

Surgical management for a rectal mass typically involves resection of the tumor with adequate margins, prioritizing total mesorectal excision (TME) for most early-stage rectal cancers, as recommended by the most recent guidelines 1. The specific approach depends on the tumor's location, size, stage, and the patient's overall health.

• For early-stage rectal cancers located in the lower rectum, a transanal excision may be performed, removing only the tumor and a small margin of surrounding tissue.
• For more advanced tumors, a low anterior resection (LAR) is common, which removes the affected portion of the rectum and reconnects the remaining rectum to the colon.
• If the tumor is very low in the rectum, an abdominoperineal resection (APR) may be necessary, involving removal of the rectum, anus, and creation of a permanent colostomy. Many patients with locally advanced rectal cancer receive neoadjuvant chemoradiation (typically 5-fluorouracil or capecitabine with radiation) for 5-6 weeks before surgery to shrink the tumor and improve surgical outcomes, as supported by recent studies 1. This approach reduces local recurrence rates and may allow for sphincter preservation in low-lying tumors. Post-surgery, adjuvant chemotherapy with FOLFOX (5-FU, leucovorin, oxaliplatin) or CAPOX (capecitabine, oxaliplatin) for 3-6 months is often recommended for stage II-III disease to reduce recurrence risk, in line with the latest clinical guidelines 1. The surgical approach aims to achieve complete tumor removal while preserving bowel function and quality of life whenever possible, with consideration of organ preservation strategies for selected patients 1.

From the Research

Surgical Management of Rectal Mass

The surgical management of a rectal mass depends on various factors, including the stage and location of the tumor, as well as the patient's overall health.

• The goal of surgical management is to remove the tumor and prevent recurrence, while also preserving anal sphincter function and maintaining quality of life 2.
• For early-stage rectal cancers (T1/T2), local excision or transanal excision may be a viable option, especially for patients with favorable histology and no lymph node involvement 3, 4.
• For more advanced rectal cancers (T3/T4), radical rectal resection with total mesorectal excision (TME) is often recommended, which may involve preoperative chemoradiation therapy to shrink the tumor 2, 5.
• In some cases, sphincter-sparing procedures such as low anterior resection with coloanal anastomosis may be possible, which can help preserve anal function and avoid the need for a permanent colostomy 5, 6.
• The choice of surgical approach depends on various factors, including the location and size of the tumor, as well as the patient's overall health and preferences 2, 3, 5, 6, 4.

Factors Influencing Surgical Management

Several factors can influence the choice of surgical management for a rectal mass, including:

• Tumor stage and location: The stage and location of the tumor can affect the choice of surgical approach, with more advanced tumors requiring more extensive surgery 2, 5.
• Lymph node involvement: The presence of lymph node involvement can affect the choice of surgical approach and the need for adjuvant therapy 2, 3.
• Patient health and preferences: The patient's overall health and preferences can influence the choice of surgical approach, with some patients preferring a more conservative approach to preserve anal function 2, 4.
• Histologic factors: The presence of adverse histologic factors, such as poor differentiation or lymphovascular invasion, can affect the choice of surgical approach and the need for adjuvant therapy 3, 4.