A 70-year-old woman presents with a 4 cm carcinoma in the mid-rectum (8 cm from the anal verge). MRI shows involvement of the mesorectal fascia (threatened circumferential resection margin). The most appropriate initial management is:
- A Immediate anterior resection
- B Long-course chemoradiotherapy followed by total mesorectal excision ✓
- C Abdominoperineal resection
- D Palliative radiotherapy alone
Correct answer: B. Long-course chemoradiotherapy followed by total mesorectal excision
Explanation
When MRI shows a threatened or involved circumferential resection margin in rectal cancer, neoadjuvant long-course chemoradiotherapy (45-50 Gy with concurrent capecitabine) is indicated to downstage the tumour before total mesorectal excision (TME). TME is the gold-standard surgical technique for rectal cancer that removes the entire mesorectal envelope and reduces local recurrence. Proceeding directly to surgery risks a positive margin. Abdominoperineal resection is reserved for very low rectal tumours involving the anal sphincter.
Reference: Bailey & Love's Short Practice of Surgery, 27th ed.
High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP
Written and medically reviewed by the StethoPrep medical team.