Recent Results
in Cancer Research
165
Managing Editors
P.M. Schlag, Berlin · H.-J. Senn, St. Gallen
Associate Editors
P. Kleihues, Zürich · F. Stiefel, Lausanne B. Groner, Frankfurt · A. Wallgren, Göteborg
Founding Editor
P. Rentchnik, Geneva
M.W. Büchler · R.J. Heald · B. Ulrich J. Weitz (Eds.)
Rectal Cancer Treatment
With 56 Figures and 64 Tables
123
Prof. Dr. med. Dr. h.c. Markus W. Büchler PD Dr. med. Jürgen Weitz
Chirurgische Universitätsklinik Heidelberg
Abteilung für Allgemeine, Viszerale, Unfallchirurgie und Poliklinik Im Neuenheimer Feld 110
69120 Heidelberg, Germany Prof. Dr. med. Bernward Ulrich Chirurgie, Krankenhaus Gerresheim Kliniken der Landeshauptstadt Gräulinger Straße 120 40625 Düsseldorf, Germany
Professor Richard John Heald OBE Surgical Director
The Pelican Cancer Foundation North Hampshire Hospital Basingstoke, Hampshire RG24 9NA, UK
Indexed in Current Contents and Index Medicus
ISBN 3-540-23341-5 Springer Berlin Heidelberg New York ISSN 0080-0015
Library of Congress Control Number: 2005920528
Bibliographic information published by Die Deutsche Bibliothek
Die Deutsche Bibliothek lists this publication in the Deutsche Nationalbibliografie;
detailed bibliographic data is available in the Internet at <http: dnd.ddb.de>.
This work is subject to copyright. All rights reserved, whether the whole or part of the material is concerned, specifically the rights of translation, reprinting, reuse of illustra- tions, recitation, broadcasting, reproduction on microfilm or in any other way, and storage in data banks. Duplication of this publication or parts thereof is permitted only under the provisions of the German Copyright Law of September, 9, 1965, in its current version, and permission for use must always be obtained from Springer-Verlag. Violations are liable for prosecution under the German Copyright Law.
Springer is a part of Springer Science+Business Media springeronline.com
© Springer-Verlag Berlin Heidelberg 2005
The use of general descriptive names, registered names, trademarks, etc. in this publication does not imply, even in the absence of a specific statement, that such names are exempt from the relevant protective laws and regulations and therefore free for general use.
Product liability: The publisher cannot guarantee the accuracy of any information about dosage and application contained in this book. In every individual case the user must check such information by consulting the relevant literature.
Editor: Dr. Ute Heilmann, Heidelberg, Germany
Desk editor: Dörthe Mennecke-Bühler, Heidelberg, Germany
Typesetting and Production: LE-TEX Jelonek, Schmidt & Vöckler GbR, Leipzig Cover design: design&production GmbH, 69121 Heidelberg, Germany Printed on acid-free paper 21 3150 YL – 5 4 3 2 1 0
Contents
Postoperative Pathophysiology and Choice of Incision . . . . 1 Richard P. Billingham
Fast-Track Colonic Surgery: Status and Perspectives . . . . 8 Henrik Kehlet
Fast-Track Surgery: The Heidelberg Experience . . . . 14 M. Kremer, A. Ulrich, M. W. Büchler, W. Uhl
Rectal Cancer: A Compartmental Disease.
The Mesorectum and Mesorectal Lymph Nodes . . . . 21 Susan Galandiuk, Kiran Chaturvedi, Boris Topor
The Pathological Assessment of Total Mesorectal Excision:
What Are the Relevant Resection Margins? . . . . 30 Frank Autschbach
Is the Lateral Lymph Node Compartment Relevant? . . . . 40 Moritz Koch, Peter Kienle, Dalibor Antolovic,
Markus W. Büchler, Jürgen Weitz
Diagnostics of Rectal Cancer: Endorectal Ultrasound . . . . 46 Hanns-Peter Knaebel, Moritz Koch, Tobias Feise,
Axel Benner, Peter Kienle
Preoperative Staging of Rectal Cancer: The MERCURY Research Project . . . 58 G. Brown, I. R. Daniels
Rectal Cancer Management: Europe Is Ahead . . . 75 R. J. Heald, I. Daniels
Teaching Efforts to Spread TME Surgery in Sweden . . . . 82 Lars Påhlman, Urban Karlbom
Learning Curve: The Surgeon as a Prognostic Factor
in Colorectal Cancer Surgery . . . . 86 Pietro Renzulli, Urban T. Laffer
VI Contents
Surgical Results of Total Mesorectal Excision
for Rectal Cancer in a Specialised Colorectal Unit . . . 105 KokSun Ho, Francis Seow-Choen
Total Mesorectal Excision: The Heidelberg Results after TME . . . 112 Alexis Ulrich, Jan Schmidt, Jürgen Weitz, Markus W. Büchler
Is Local Excision of T2/T3 Rectal Cancers Adequate? . . . 120 D. L. Beral, J. R. T. Monson
Operative Treatment of Locally Recurrent Rectal Cancer . . . 136 Johan N. Wiig, Stein G. Larsen, Karl-Erik Giercksky
Laparoscopic TME: Better Vision, Better Results? . . . 148 T. H. K. Schiedeck, F. Fischer, C. Gondeck, U. J. Roblick,
H. P. Bruch
Laparoscopic TME – The Surgeon’s or the Patient’s Preference . . . 158 J. Göhl, S. Merkel, W. Hohenberger
Laparoscopic Total Mesorectal Excision – The Turin Experience . . . 167 M. Morino, G. Giraudo
Evacuation of Neorectal Reservoirs after TME . . . 180 J. S. Köninger, M. Butters, J. D. Redecke, K. Z’graggen
Long-Term Functional Results
After Straight or Colonic J-Pouch Coloanal Anastomosis . . . 191 Guillaume Portier, Ivan Platonoff, Frank Lazorthes
Urinary and Sexual Function After Total Mesorectal Excision . . . 196 Christoph A. Maurer
Functional Results of the Colon J-Pouch Versus Transverse Coloplasty Pouch in Heidelberg . . . 205
Alexis Ulrich, Kaspar Z’graggen, Jürgen Weitz, Markus W. Büchler
Indications for Neoadjuvant Long-Term Radiotherapy . . . 212 Lars Påhlman
Neoadjuvant Radiotherapy and Radiochemotherapy for Rectal Cancer . . . . 221 Claus Rödel, Rolf Sauer
Adjuvant Radiochemotherapy for Rectal Cancer . . . 231 Martina Treiber, R. Krempien, H. P. Knaebel, J. Debus
Contents VII
Intraoperative Radiotherapy for Rectal Carcinoma . . . 238 Martina Treiber, S. Oertel, J. Weitz, R. Krempien, M. Bischof, M. Wannenmacher, M. Büchler, J. Debus
Indications and Effect on Survival of Standard Chemotherapy
in Advanced Colorectal Cancer . . . 245 Birgit Kallinowski
New Chemotherapeutic Strategies in Colorectal Cancer . . . 250 Markus Moehler, Andreas Teufel, Peter R. Galle
Active Specific Immunotherapy in Colon Cancer . . . 260 A. J. M. van den Eertwegh
Radiofrequency Ablation in Metastatic Disease . . . 268 Andreas Lubienski
