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J.Jpn. Surg. Soc.. 119(5): 488-495, 2018

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Division of Surgical Oncology, Department of Surgery, Nagoya University Graduate School of Medicine, Nagoya, Japan

Keisuke Uehara, Toshisada Aiba, Tosiki Mukai, Akihiro Tomita, Aya Tanaka, Tomoki Ebata, Masato Nagino

R0 resection is essential for cure in patients with cT4b rectal cancer. For curative resection, extended surgery such as pelvic exenteration is often required, meaning that surgeons must stand throughout a demanding procedure. We report a surgical strategy for locally advanced rectal cancer involving the anterior neighboring organs, which include the urinary bladder, seminal vesicle, and prostate in men, and the urinary bladder, uterus, and vagina in women. Various types of surgery are performed based on gender, site of tumor, and extent of tumor. The most important aspects are investigating the preoperative images such as with computed tomography and magnetic resonance imaging, constructing a mental three-dimensional image of the pelvis, and deciding how to remove the tumor with safe margins. Although we are likely to attempt organ-preserving surgery, it is more difficult, complex, and involves the risk of positive margins compared with extended surgery. If we cannot obtain clear surgical views in the planned surgical procedure, organ preservation may prove impossible. It should be kept in mind that most patients desire cure rather than organ preservation.

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