直肠癌 surgical margin

原贴01/2019

http://bbs.wenxuecity.com/health/820325.html

MRI: 

Mid rectal cancer (5 to 10 cm)., T3a N2. The anal sphincer is not involved. The circumferential resection margin is threatened by a mesorectal lymph node/tumor deposit. Findings suspicious for EMVI are present.

 

CT:

Several rounded and mildly enlarged lymph modes identified in the presacral space along the IMV chain raising the possibility of metastatic disease.

Primary rectal tumor is not appreciated on CT scan

No evidence for metastatic disease otherwise in the chest, abdomen or Pelvis.

 

五个cycle of  xeloda/oxaliplatin以后, now in the middle of xeloda/radiation

06/2019 MRI report

asymetric upper rectal wall thickening is again present but substantially decreased in thickness/bulk. The tumor extends for up to 3.5 cm in craniocaudad length now compared to 5.5 cm previsouly. The lower margin of the mass terminates approximately 4.5cm cephalad to the anal sphincter. Previously seen minimal invasion into the perirectal fat left of midline appears improved. There is no necrosis. 

No pelvic free fluid is seen. The bladder appears unremarkable. Previously seen enlarged lower IMA chain/perirectal/presacral lymph nodes have resolved.

不知道surgical margin 在放疗以后会不会更好一点, 现在4.5cm风险大不大? 多谢