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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].
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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].
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).
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.
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].
Indeed the authors found some evidence that disease progression during neoadjuvant treatment may have occurred in this subgroup of patients - extended resections were more commonly required and a longer median survival for patients treated with surgery alone prior to the incorporation of peri-oerative chemotherapy into the French guidelines for GA in 2006.
Wedge resection is often performed for a peripheral nodule, but more extensive resection is required when wedge resection would not achieve complete resection [10].
No more extended adolescence for me.
(Kornhauser [2004] provides a more extended account).
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