Evangeline Preeti Jennifer, (2020) Identification of Predictive Factors for Resectability in Non metastatic Carcinoma Rectum. Masters thesis, Christian Medical College, Vellore.
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Abstract
INTRODUCTION: Colorectal cancer is the third most common cancer in the world. Approximately 60% of cases are seen in developed countries. In the United States there are approximately 43,030 newly diagnosed rectal cancer patients each year. It is also the third most common cause of female mortality and second most common cause of male mortality in the United States. In India, in men, colon cancer is the 8th and rectal is the 9th most common cancer seen in men. However, in women, rectal cancer is less common than colon cancer which is the 9th most common cancer. AIM OF THE STUDY: To identify predictive factors for resectability in non-metastatic carcinoma rectum. OBJECTIVES: To identify clinical, pathological and radiological factors to predict risk for resectability in non-metastatic carcinoma rectum. METHODOLOGY: A total of 144 patients who were diagnosed with non-metastatic carcinoma rectum and discussed in the Multidisciplinary Tumor Board Meeting during the period of January 2015 to December 2017 in the Department of Surgery II at CMC Hospital were recruited. RESULTS AND CONCLUSION: This study was planned to predict factors that affect resectability in non metastatic carcinoma rectum. This was to help patients understand their diagnosis and treatment process better at the time of presenting to us in the Outpatient Department. The important facts from this study in that regard are: • Rectal carcinoma is more common after 40 years of age, however the age does not help in predicting if the tumour is resectable. • Resectability cannot be predicted based on the sex of the individual. • Though studies show morbidity is a risk factor for non resectable tumours, this study could not establish a significant correlation regarding the same. It was noted that there were more underweight patients in the non resectable group probably owing to long duration of symptoms, obsruction and poor nutrition. • If the duration of symptoms is longer than 2 years there is a significant chance of the tumour being non resectable. • The risk of non respectability is higher if the growth is obstructed or has restricted mobility. This fact is shown in other studies, however could not be proved in this study since there were many cases were the details were not documented. • Moderately differentiated carcinoma was the most common histopathological type of tumour. There was a higher number of poorly differentiated adencarcinoma in the non resectable group, however it wasn’t significant to predict that patients with poorly differentiated adenocarcinoma have higher chance of having non resectable tumours. • Circumferential Resection Margin (CRM) is an important predictor of resectability as seen in other studies. In this study also it was found to be significantly higher in non resectable tumour group and in patients receiving neoadjuvant chemoradiation. So it can be used as a valuable predictor while making the treatment plan for a patient with non metastatic rectal carcinoma. • Extramural Venous Invasion (EMVI) is also an important predictor of respectability based on other studies. In this study it proved to be a valuable indicator of non resectability and for patients requiring multimodality treatment. • Nodal involvement is considered as an important predictor of resectability. However in this study there was no significant difference between the resectable and non resectable groups. In the resectable group, patients with lymph node involvement underwent multimodality treatment. • In tumour staging it is known that higher the T stage the higher the chance of non Resectability. Similarly in our study it was noted that patients with T4 disease had a significantly higher risk of having non resectable tumour.
| Item Type: | Thesis (Masters) |
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| Additional Information: | 221511452 |
| Uncontrolled Keywords: | Non-metastatic carcinoma rectum, Resectability, Predictive factors. |
| Subjects: | MEDICAL > General Surgery |
| Depositing User: | Subramani R |
| Date Deposited: | 12 Feb 2021 16:27 |
| Last Modified: | 12 Feb 2021 16:27 |
| URI: | http://repository-tnmgrmu.ac.in/id/eprint/14061 |
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