Patient: Description of the condition (onset time, main symptoms, hospital visited, etc.): Patient female, 50, blood in stool for 4 months, later examined as rectal cancer hospitalized for resection, now postoperative, recovery is okay, ileal protective stoma, just always feel the urge to stool Laparoscopic-assisted surgery dixon Pathology report, tumor site: rectum, size: 2*2, type: ulcerated Histology: moderately differentiated adenocarcinoma cut margin Infiltration: invasion to deep muscular layer, close to the epithelium Metastasis: 12 peri-intestinal lymphs on self examination no cancer metastasis. 1. I would like to ask the physician whether chemotherapy is the next step, our physicians are not in agreement, her pathology says that it is close to the outer membrane, whether it is a high risk factor; 2. Thank you for taking the time to answer! Tu Shiliang: According to your description, the tumor stage should be T2N0M0, which is a relatively early stage tumor; the ileal prophylactic fistula should be a low-grade rectal cancer. Referring to the 2010 version of our colorectal cancer diagnosis and treatment specification, postoperative adjuvant therapy is not recommended. If you want to reduce the risk of recurrence, adjuvant radiotherapy can be performed without chemotherapy. Patient: Thank you, Dr. Tu, for your answer. Yes, it is a low tumor, 6cm in size. Patient: Hello doctor, I still have some questions about the laparoscopic-assisted minimally invasive surgery, is it reasonable that the lymph nodes were not cleared during the surgery, because the pathology report says “self-examined peri-intestinal lymph”, that is, the lymph was taken by the pathology department. It is true that the surgical procedure record does not mention the lymph node clearance, is it because the minimally invasive one is not convenient to clear? The surgical method was chosen by our family, and we did not know it at that time in an emergency, so we only chose the costly one. Tu Shiliang: Whether it is laparoscopic or conventional surgery, regional lymph node clearance should be routinely performed. Self-checked lymph nodes should be taken and checked by the surgeon after the surgery. The 12 lymph nodes sent for examination for rectal cancer meet the requirements. The timing of radiotherapy should be started within 1 postoperative period. There are standard protocols and doses, no need to choose. Patient: Thank you, Dr. Tu, I am so much relieved after you said so Patient: Dr. Tu, come again for advice. We went to the oncology hospital today for a pathology consultation, and the consultation opinion is as follows 1. medium differentiated adenocarcinoma of rectal ulcer type, infiltrating deep muscular layer, focal area invading the outer membrane 2. 12 lymph nodes around the intestine without metastasis Remarks: the intestinal stump cut edge is negative Now there is a small difference between the pathology and the last time, in this case, do we need to do chemotherapy again, and if chemotherapy is now 36 days postoperative, will the effect be affected? Patient: I would like to add that the pathologist explained to me that “between the deep muscle layer and the outer membrane, the central part of the focal point is attached to the outer membrane”. Tu Shiliang: Adjuvant radiotherapy is recommended. Patient: Thank you, doctor!