Rectal Cancer New Frontiers in Diagnosis,Treatment and Rehabilitation

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Rectal Cancer

New Frontiers in Diagnosis, Treatment and Rehabilitation

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Gian Gaetano Delaini

Rectal Cancer

New Frontiers in Diagnosis, Treatment and

Rehabilitation

Foreword by

R.J. Nicholls

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Gian Gaetano Delaini

Department of Surgery and Gastroenterology University of Verona

Verona, Italy

Library of Congress Control Number:2005931120

ISBN 88-470-0342-3 Springer Milan Berlin Heidelberg New York

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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 grad- ual recognition that local recurrence was the appropriate end-point for local and regional treatments such as surgery and radiotherapy. Risk factors for local recurrence be- came 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 in- spiring 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 refer- ences 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 sum- marise 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 pres- ent 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

Foreword

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Rectal Cancer. Epidemiology and Burden of Disease

Stefano Tardivo, William Mantovani, Emanuele Torri, Albino Poli. . . 1 Diagnostic Imaging: Diagnosis and Staging

Riccardo Manfredi, Giulia Zamboni, Giovanni Carbognin, Farah Moore,

Rossella Graziani. . . 23 Pre-Operative Staging: Endorectal Ultrasound

Giulio Aniello Santoro, Carlo Ratto . . . 35 Predictive Markers in Physiology and Anatomy for Outcomes in Rectal

Cancer Patients

Johann Pfeifer. . . 51 Rectal Cancer: Pathological Features and their Relationship to Prognosis

and Treatment

Paola Capelli, Sara Pecori, Guido Martignoni, Laura Bortesi, Marta Gobbato,

Fabio Menestrina. . . 57 TME: How to Interpret the Favourable Results?

Leif Hultèn, Gian Gaetano Delaini, Marco Scaglia, Gianluca Colucci. . . 73 Lateral Pelvic Lymph Node Dissection (LPLD) in Rectal Cancer: an Overview

Filippo Nifosí, Michele Rossi, Gianluca Colucci, Gian Gaetano Delaini. . . 79 Controversial Issues in Rectal Cancer Surgery

Leif Hultèn, Gian Gaetano Delaini, Marco Scaglia, Gianluca Colucci. . . 85 Rectal Cancer and Quality of Life

Gian Gaetano Delaini, Gianluca Colucci. . . 89 Mechanical Bowel Preparation (MBP) and Probiotic Administration

Before Colorectal Surgery

Gerardo Mangiante, Annalisa Castelli, Birgit Feil. . . 97 Indications for Local Excision in Rectal Cancer Surgery

Diego Segre, Paola Sorba Casalegno, Herbert M. Dal Corso,

Gian Gaetano Delaini, Felice Borghi. . . 101 Local Excision of Rectal Cancer: TEM

Tomas˘ Skricka . . . 107 Low Anterior Resection

Adam Dziki . . . 115

Contributors

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X Contributors

DANILODONATI

ADAMDZIKI

Department of General and Colorectal Surgery

Medical University Lodz, Poland BIRGITFEIL

Thoracic Surgery Unit Verona City Hospital Verona, Italy

GIAMMARIAFIORENTINI

ANTONIOGIULIANI

1^stDivision of General Surgery 2^ndUniversity of Naples Naples, Italy

MARTAGOBBATO

ROSSELLAGRAZIANI

ALFREDOGUGLIELMI

1^stDepartment of General Surgery Maggiore Hospital

Verona, Italy

ZORANKRIVOKAPIC

1^stSurgical Clinic Clinical Center Serbia Belgrade, Serbia-Montenegro LEIFHULTÉN

Professor of Surgery Colorectal Unit

Sahlgrenska University Hospital Goteborg, Sweden

ANDREAMAMBRINI

RICCARDOMANFREDI

GERARDOMANGIANTE

WILLIAMMANTOVANI

Department of Medicine and Public Health University of Verona

Verona, Italy

PETERMARINELLO

2^ndDepartment of General Surgery Regional Hospital of Bolzano Bolzano, Italy

GUIDOMARTIGNONI

NICOLAMENIN

Center for Minimally Invasive and Robotic Surgery

FABIOMENESTRINA

Department of Pathology University of Verona Verona, Italy FARAHMOORE

EMILIOMORPURGO

Center for Minimally Invasive and Robotic Surgery

FILIPPONIFOSÌ

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XI

CRISTINAOLIANI

Oncology Unit Montecchi Maggiore Verona, Italy

SILVIAPACHERA

1^stDepartment of General Surgery Maggiore Hospital

Verona, Italy

MARTINAPADOVANI

Oncology Unit Montecchi Maggiore Verona, Italy SARAPECORI

JOHANNPFEIFER

Department of Surgery Medical University of Graz Graz, Austria

ANTONIOB. PORCARO

Unit of Radiotherapy Oncology Istituti Ospitalieri of Verona Verona, Italy

CARLORATTO

Department of Surgical Sciences Catholic University

Roma, Italy

GIOVANNIROMANO

1^stSurgical Clinic S.G. Moscati Hospital Avellino, Italy

MARIOROMANO

Unit of Radiotherapy Oncology Istituti Ospitalieri of Verona Verona, Italy

MICHELEROSSI

ANDREARUZZENENTE

1st Department of General Surgery Maggiore Hospital

Verona, Italy

GIULIOA.SANTORO

Section of Anorectal Physiology and Ultrasound

Department of Surgery Regional Hospital Treviso, Italy

MARCOSCAGLIA

Department of Surgery San Luigi Gonzaga Hospital Orbassano, Torino, Italy

GUIDOSCIAUDONE

DIEGOSEGRE

FRANCESCOSELVAGGI

ALBERTOSERVENTI

Department of Colorectal and Proctologic Surgery

Galliera Hospital Genova, Italy

THOMASˇSKRICKA

Bakesˇ Memorial Hospital Brno, Czech Republic

PAOLASORBACASALEGNO

STEFANOTARDIVO

Verona, Italy

ALBINOTORRI

Verona, Italy

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XII Contributors

EMANUELETORRI

Department of Medicine and Public Health

PETRTSARKOV

State Scientific Center of Coloproctology Moscow, Russia

GIULIAZAMBONI

Rectal Cancer New Frontiers in Diagnosis,Treatment and Rehabilitation

Rectal Cancer

Gian Gaetano Delaini

Rectal Cancer

New Frontiers in Diagnosis, Treatment and

Rehabilitation

Foreword by

R.J. Nicholls

Foreword

Contents

Contributors