Inhaltsverzeichnis

Vorwort

Foreword

Twenty years ago rectal cancer was treated almost exclusively by surgery. This often took the form of total rectal excision resulting in a permanent colostomy. The quality of surgery was variable and the results were often unknown. The last 20 years have seen a remarkable transition due to various factors. Perhaps the most important was the gradual recognition that local recurrence was the appropriate end-point for local and regional treatments such as surgery and radiotherapy. Risk factors for local recurrence became identified by histopathologists and these began to be identified pre-operatively, initially by clinical examination and subsequently by imaging.

Computerised tomography, endorectal ultrasound and magnetic resonance are now capable of anticipating the pathology with sufficient accuracy to identify the degree of risk of local recurrence before treatment. This has allowed the rational development of management strategies whether they include neoadjuvant chemoradiotherapy or less invasive surgery such as local excision. Improved staging has also been at the centre of the move from excisional to restorative major surgery, with total mesorectal excision inspiring more careful dissection mindful of the locoregional pathology. While survival and freedom from local recurrence are the main end-points of treatment, function has become increasingly important as part of the measure of quality of life.

In Rectal Cancer: New Frontiers in Diagnosis, Treatment and Rehabilitation, all these developments are dealt with by expert authors. The editing has been uniform to create a balanced account of the areas of importance in rectal cancer as treated today. The references in each chapter are numerous and up-to-date and will be a valuable resource to the reader. There are chapters on surgical technique and choice of operation, which summarise with authority the present state of knowledge. Staging and multimodality treatment including the management of stage IV disease are dealt with in detail. Techniques to improve function by providing continence after removal of the anal sphincter and colonic reservoirs are also reviewed.

Taken as a whole, Rectal Cancer is an informative and accurate summary of the present position. It has focused on the areas of development and contention. The book will be a very useful contribution to the knowledge of trained practitioners and trainees alike.

R. John Nicholls

Klappentext

Despite lifestyle improvements, the incidence of rectal cancer is increasing in industrialised countries. Rapid advances in technology, growing knowledge of the biological history of the disease and closer attention to patients' quality of life after surgery have led to a less invasive approach. In the last 15 years, the surgical approach has shifted from extended resection to sphincter-saving procedures, featuring a multidisciplinary approach and a high level of specialisation. The experienced surgeon can plan and choose the "right treatment for the right patient" only with the support of the radiologist, endoscopist and pathologist (preoperative staging), oncologist and radiotherapist (neoadjuvant therapy), and psychologist and stomatherapist (rehabilitation). In addition, the problems of salvage procedure and the reconstruction of anal sphincter after abdominal resection are explored. The aim of this book is to clarify the rapid advances and to offer guidelines for physicians dealing with rectal cancer. Taking into account indications, contraindications, risks, benefits and controversies, the authors offer clear and practice-oriented answers for a wide range of specialists and experts, as well as those new to the field.

Delaini

Editor

Rectal Cancer

New Frontiers in Diagnosis, Treatment and Rehabilitation

ISBN 88-470-0342-3

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Subject Index

A

abdominoperineal resection 59, 87, 108, 114, 126
adenoma 10, 12, 27, 40-42, 52, 57, 112, 114
adjuvant radiotherapy 26, 44, 122
anal canal 35-49
anorectal reconstruction 177, 183, 186, 187
anterior resection syndrome 134, 137
artificial bowel sphincter 137, 177

C

chemotherapy 215-220, 243-251
colo-anal procedure 131-136
colonic
colonic pouch 54, 119, 139, 149, 150
colonic reservoir 119, 120, 132, 137, 138, 141, 150
combination radiochemotherapy 215-220

D

dynamic graciloplasty 183, 186

E

electrostimulation 177, 183, 185
EMG 149-152
endoprobe 35
epidemiology 1, 197
extrafascial excision 76

F

fecal continence 177-182

H

hepatic
hepatic metastases 79, 192, 227-233, 237, 238
hepatic resection 228-232, 234-236, 238
hyperthermia 58, 89, 209, 218, 223, 224

I

intestinal anastomosis 26

L

laparoscopy 167-169, 171, 193, 229, 236
local
local excision 35, 41, 44, 52, 101, 105-108, 112, 131, 190, 191, 194, 208
local recurrence 30, 31, 51, 54, 55, 58, 63, 64, 67, 7376, 92, 102, 104, 105, 108, 111, 112, 116, 117, 120-125, 134, 135, 157, 181, 184, 189-194, 203-210, 215-217, 221-224, 237, 238, 243
low anterior resection 54, 59, 64, 74, 85-87, 109, 115, 147, 148, 150, 154, 193, 203, 204

M

manovolumetry 148, 151
multimodality approach 106

N

neoadjuvant treatment 26, 31, 181, 206, 209, 210, 219, 221
neoadjuvant therapy 52, 67, 89, 91, 122, 137, 142, 208, 221, 232

P

pelvic floor 23, 38, 53, 92, 116, 148, 186, 187
pelvic lymph node dissection 79-81
perineal colostomy 132, 177, 178, 180, 183, 184, 186, 187
probiotic 97, 98
proctoscope 37, 38, 111
prognostic factors 48, 67-69, 102, 122, 123, 191, 194, 219, 229, 230

R

radicality 73, 75, 85, 87, 116, 117, 154, 190, 231
rectal cancer
- CT and MRI 35, 103, 228
- diagnosis 227
- quality of life 89
- metastatic 243
- pitfalls in rectal cancer surgery 51
- staging 29, 39
- surgical technique 51, 54, 58, 64, 73, 76, 115, 116, 132, 170, 183, 184, 190, 198

S

salvage surgery 105, 189-191, 193, 194, 208, 210
sphincter saving procedure 86, 89, 91, 137, 154, 190, 206
staging 203-205, 207, 210, 221, 223, 228
surgical indications 24, 231

T

Transanal Endoscopic Microsurgery 108, 109
transducer 35-37, 42, 45, 47, 209
TEM 107-114, 160

U

ultrasound
- endorectal ultrasound 35, 191, 203
- endoluminal ultrasound 37, 38, 47, 112