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These patients require a more extended resection, peripheral to the mesorectal fascia.
This finding could be an argument for restaging after neoadjuvant therapy, and to consider more prolonged neoadjuvant treatment, or to refer to a specialised centre for more extended resection or additional boosting of the area at risk [17].
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Studies examining the vocal parameters in patients treated with laser cordectomy noted that fundamental frequency (F0) tends to be higher in patients for more extended resections [ 22, 29– 31].
A more extended tumor resection undoubtedly risks function preservation especially in critical areas.
For example, if a tumour is shown to have downsized and retracted from initially invaded organs and/or the MRF, a standard total mesorectal excision (TME) instead of a more extended pelvic resection can be considered.
Randomised studies that compared standard D1 lymph node dissections with more extended D2 resections in the Western world, failed to show a significant survival benefit with more extensive surgery (Cuschieri et al, 1999; Hartgrink et al, 2004).
Accordingly, the extended septal myectomy in this cohort was a much more extensive resection (Figs 4– 6) compared with the original Morrow procedure described almost half a century ago [ 9].
Wedge resection is often performed for a peripheral nodule, but more extensive resection is required when wedge resection would not achieve complete resection [10].
When a residual tumour was visualised and deemed resectable, an extended resection was performed, followed by another MRI scan.
The median survival for extended resection group was 8.0 months and for no extended resection group was 15.0 months (P = 0.004) (Fig. 2).
If a surgically resectable tumour was observed in the peri-operative images, an extended resection was performed, followed by a new imaging sequence.
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