Note: Page numbers of article titles are in boldface type. A Abdominoperineal excision, of rectal cancer, 93 111 current controversies in, 106 109 extent of perineal dissection and removal of pelvic floor, 106 107 positioning of patient for, 107 108 reconstruction of pelvic floor, 108 109 extralevator, 99 103 intersphincteric, 99 ischioanal, 103 106 new concept of, 97 99 problems with convention synchronous combined, 95 97 Adenomas, detection rate with colonoscopy, 3 4 avoiding missed, 6 7 reasons for missed, 4 Adjuvant chemotherapy, for colorectal cancer, 49 58 challenges and barriers to, 52 53 importance of timing, 51 52 Age, and functional consequences of colorectal cancer management, 128 129, 133 134, 137 Anatomy, rectal, relevant to imaging in rectal cancer, 60 64 Antibiotics, prophylactic, in colon and rectal cancer surgery, 15 16 B Bowel dysfunction, after treatment of colorectal cancer, 128 132 colon cancer, 128 patient factors, 128 129 rectal cancer, 128 treatment factors, 129 132 tumor factors, 129 C Cancer prevention, role of colonoscopy in, 2 3 Central vascular ligation, with complete mesocolic excision, 28 29 Chemoradiation, in rectal cancer, management of complete response after, 113 125 assessing response, 117 119 defining complete response, 114 future studies, 119 121 interpreting the literature, 114 117 neoadjuvant, of rectal cancer, controversies in, 79 92 choice of drugs and combination with radiation, 81 84 Surg Oncol Clin N Am 23 (2014) 161 170 http://dx.doi.org/10.1016/s1055-3207(13)00120-8 surgonc.theclinics.com 1055-3207/14/$ see front matter ª 2014 Elsevier Inc. All rights reserved.
162 Chemoradiation (continued ) efficacy of endocavitary radiation, 86 optimum timing of surgery after radiation, 84 85 preferred radiation protocol for superficial cancers, 86 protocol of, efficacy and toxicity, 81 radiation use in all cases or on selective basis only, 85 Chemotherapy, adjuvant, for colorectal cancer, 49 58 challenges and barriers to, 52 53 importance of timing, 51 52 neoadjuvant radiation and, for rectal cancer, 79 92 with radiation for rectal cancer, management of complete response after, 113 125 Colectomy, single-incision laparoscopic, 43 Colon cancer. See also Colorectal cancer. adequacy of colon resection in, 25 34 complete mesocolic excision with central vascular ligation, 28 29 current surgical practice for, 26 evidence to support, 26 27 how can we improve outcome of, 28 improved lymph node yield and survival, 30 31 which lymph nodes do tumors spread to, 29 30 functional consequences of management, 127 149 bowel function, 128 132 future improvements in, 139 142 sexual function, 132 136 urinary function, 136 139 laparoscopy for, controversies in, 36 38 long-term oncologic outcomes, 37 38 operative and short-term outcomes, 36 37 technical quality factors in surgery for, 11 12 adjuvant chemotherapy, 12 en bloc resection for T4 lesions, 12 laparoscopy, 12 lymphadenectomy and vessel ligation, 11 12 prophylactic oophorectomy, 12 synchronous cancers, 12 Colonoscopy, 1 9 adenoma detection rates, 3 4 aims of, 2 and cancer prevention, 2 3 avoiding missed lesions, 6 7 bowel preparation, 6 instrumental and technical measures, 7 pattern recognition, 6 reinforcements, 7 technique, 6 in high-risk colons, 5 6 miss rates, 3 reasons for missing adenomas, 4 serrated polyp detection, 4 5 Colorectal cancer, 1 160 abdominoperineal excision of rectal cancer, 93 111
current controversies in, 106 109 extralevator, 99 103 intersphincteric, 99 ischioanal, 103 106 new concept of, 97 99 problems with convention synchronous combined, 95 97 adjuvant chemotherapy for, 49 58 challenges and barriers to, 52 53 importance of timing, 51 52 chemoradiation in rectal cancer, management of complete response, 113 125 assessing response, 117 119 defining complete response, 114 future studies, 119 121 interpreting the literature, 114 117 colon resection, 25 34 complete mesocolic excision with central vascular ligation, 28 29 current surgical practice for, 26 evidence to support, 26 27 how can we improve outcome of, 28 improved lymph node yield and survival, 30 31 which lymph nodes do tumors spread to, 29 30 colonoscopy, 1 9 adenoma detection rates, 3 4 aims of, 2 and cancer prevention, 2 3 avoiding missed lesions, 6 7 bowel preparation, 6 instrumental and technical measures, 7 pattern recognition, 6 reinforcements, 7 technique, 6 in high-risk colons, 5 6 miss rates, 3 reasons for missing adenomas, 4 serrated polyp detection, 4 5 functional consequences of management, 127 149 bowel function, 128 132 future improvements in, 139 142 sexual function, 132 136 urinary function, 136 139 imaging in rectal cancer, 59 77 laparoscopy for, controversies in, 35 47 colon cancer, 36 38 conversion rates, 40 41 cost-effectiveness, 41 in the elderly, 41 42 163
164 Colorectal (continued) learning curve for, 42 lymph node harvest, 41 obesity and, 41 pelvic nerves, 42 rectal cancer, 38 40 robotic surgery for rectal cancer, 43 single-incision laparoscopic colectomy, 43 neoadjuvant chemoradiation of rectal cancer, 79 92 choice of drugs and combination with radiation, 81 84 efficacy of endocavitary radiation, 86 optimum timing of surgery after radiation, 84 85 preferred radiation protocol for superficial cancers, 86 protocol of, efficacy and toxicity, 81 radiation use in all cases or on selective basis only, 85 newly diagnosed, with synchronous stage 4 disease, 151 160 approach to stage 4 metastasis, 155 159 to liver, 155 158 to lung, 158 to peritoneum, 158 159 detecting the synchronous tumor, 152 153 need for immediate palliative surgery for primary tumor, 153 154 type and extent of metastatic disease, 154 155 quality assurance in surgery for, 11 23 appropriate prophylactic antibiotic use, 15 16 impact of postoperative complications, 17 18 system quality factors, 14 15 technical factors, 11 14 colon cancer, 11 12 rectal cancer, 13 14 venous thromboembolism prevention, 16 17 Complete clinical response, management of, in rectal cancer after chemoradiation, 113 125 assessing response, 117 119 defining complete response, 114 future studies, 119 121 interpreting the literature, 114 117 Complete mesocolic excision, with central vascular ligation, 28 29 Cost-effectiveness, of laparoscopy in colon and rectal cancer, 41 E Elderly patients, laparoscopy for colon and rectal cancer in, 41 42 Endocavitary radiation, efficacy in rectal cancer, 86 Endorectal ultrasonography (ERUS), vs. MRI in rectal cancer, 59 77 Extralevator abdominoperineal resection (ELAPE), for rectal cancer, 99 103
165 pelvic dissection in, 100 101 perineal part of, 101 103 F Familial adenomatous polyposis, colonoscopy in patients with attenuated, 5 6 Functional consequences, of colorectal cancer management, 127 149 bowel function, 128 132 future improvements in, 139 142 sexual function, 132 136 urinary function, 136 139 G Gender, and functional consequences of colorectal cancer management, 129, 134, 137 138 I Imaging, in rectal cancer, MRI vs. endorectal ultrasonography, 59 77 Impotence, after colorectal cancer. See Sexual dysfunction. Incontinence, after colorectal cancer. See Bowel dysfunction and Urinary dysfunction. Ischioanal abdominoperineal resection, for rectal cancer, 103 106 perineal part of, 104 106 L Laparoscopy, for colorectal cancer, controversies in, 35 47 colon cancer, 36 38 conversion rates, 40 41 cost-effectiveness, 41 in the elderly, 41 42 learning curve for, 42 lymph node harvest, 41 obesity and, 41 pelvic nerves, 42 rectal cancer, 38 40 robotic surgery for rectal cancer, 43 single-incision laparoscopic colectomy, 43 Learning curve, for laparoscopy for colon and rectal cancer, 42 Liver, stage 4 colorectal cancer metastasis to, 155 158 Lung, stage 4 colorectal cancer metastasis to, 158 Lymph nodes, harvest of, laparoscopic vs. open, 41 improved yield and improved survival in colon cancer, 30 31 nodal metastases in rectal cancer, MRI vs. ERUS in detection of, 74 spread of colonic tumors to, 29 30 Lynch syndrome, colonoscopy in patients with, 5 6
166 M Magnetic resonance imaging (MRI), vs. endorectal ultrasonography in rectal cancer, 59 77 Mesocolic excision, complete, with central vascular ligation, 28 29 Mesorectal fascia, MRI vs. ERUS in detection of neoplastic involvement, 74 76 Metastasis, approach to newly diagnosed colorectal cancer with synchronous stage 4 disease, 151 160 approach to stage 4 metastasis, 155 159 to liver, 155 158 to lung, 158 to peritoneum, 158 159 detecting the synchronous tumor, 152 153 need for immediate palliative surgery for primary tumor, 153 154 nodal, MRI vs. ERUS in diagnosis of in rectal cancer, 74 type and extent of metastatic disease, 154 155 Missed lesions, on colonoscopy, 1 9 rate of, 3 reasons for, 4 ways to avoid, 6 7 bowel preparation, 6 instrumental and technical measures, 7 pattern recognition, 6 reinforcements, 7 technique, 6 N Neoadjuvant therapy, chemoradiation of rectal cancer, controversies in, 79 92 choice of drugs and combination with radiation, 81 84 efficacy of endocavitary radiation, 86 optimum timing of surgery after radiation, 84 85 preferred radiation protocol for superficial cancers, 86 protocol of, efficacy and toxicity, 81 radiation use in all cases or on selective basis only, 85 management of complete response after chemoradiation in rectal cancer, 113 125 assessing response, 117 119 defining complete response, 114 future studies, 119 121 interpreting the literature, 114 117 Nerve damage, risk of, in laparoscopy for colon and rectal cancer, 42 O Obesity, impact on laparoscopy in colon and rectal cancer, 41 Outcomes, improvement of, in colon cancer surgery, 28 quality assurance in colon and rectal cancer surgery, 11 23 appropriate prophylactic antibiotic use, 15 16
167 impact of postoperative complications, 17 18 system quality factors, 14 15 technical factors, 11 14 colon cancer, 11 12 rectal cancer, 13 14 venous thromboembolism prevention, 16 17 P Peritoneum, stage 4 colorectal cancer metastasis to, 158 159 Polyps, serrated, detection on colonoscopy, 4 5 Postoperative complications, impact on colon and rectal cancer surgery, 17 18 Prophylactic antibiotics, appropriate use in colon and rectal cancer surgery, 15 16 Q Quality assurance, in colon and rectal cancer surgery, 11 23 appropriate prophylactic antibiotic use, 15 16 impact of postoperative complications, 17 18 system quality factors, 14 15 technical factors, 11 14 colon cancer, 11 12 rectal cancer, 13 14 venous thromboembolism prevention, 16 17 R Radiation therapy, neoadjuvant with chemotherapy, of rectal cancer, 79 92 choice of drugs and combination with, 81 84 efficacy of endocavitary, 86 optimum timing of surgery after, 84 85 preferred radiation protocol for superficial cancers, 86 protocol of, efficacy and toxicity, 81 radiation use in all cases or on selective basis only, 85 with chemotherapy for rectal cancer, management of complete response after, 113 125 Rectal cancer. See also Colorectal cancer. abdominoperineal excision of, 93 111 current controversies in, 106 109 extralevator, 99 103 intersphincteric, 99 ischioanal, 103 106 new concept of, 97 99 problems with convention synchronous combined, 95 97 functional consequences of management, 127 149 bowel function, 128 132 future improvements in, 139 142 sexual function, 132 136 urinary function, 136 139 imaging in, MRI vs. endorectal ultrasonography, 59 77
168 Rectal (continued ) laparoscopy for, controversies in, 38 40 long-term outcomes, 40 short-term outcomes, 38 39 management of complete response after chemoradiation, 113 125 assessing response, 117 119 defining complete response, 114 future studies, 119 121 interpreting the literature, 114 117 neoadjuvant chemoradiation of, controversies in, 79 92 choice of drugs and combination with radiation, 81 84 efficacy of endocavitary radiation, 86 optimum timing of surgery after radiation, 84 85 preferred radiation protocol for superficial cancers, 86 protocol of, efficacy and toxicity, 81 radiation use in all cases or on selective basis only, 85 robotic surgery for, 43 technical quality factors in surgery for, 13 14 abdominoperineal resection technique, 14 laparoscopy, 14 local excision, 13 lymphadenectomy, 14 margins, 14 neoadjuvant chemoradiation, 13 staging, 13 total mesorectal excision, 13 14 vascular ligation, 13 Robotic surgery, for rectal cancer, 43 S Serrated polyps, detection on colonoscopy, 4 5 Sexual dysfunction, after treatment of colorectal cancer, 132 136 colon cancer, 132 133 patient factors, 133 134 rectal cancer, 133 treatment factors, 135 136 tumor factors, 134 Staging, of rectal cancer, MRI vs. ERUS in, 71 74 Surgery, for colorectal cancer, abdominoperineal excision of rectal cancer, 93 111 current controversies in, 106 109 extralevator, 99 103 intersphincteric, 99 ischioanal, 103 106 new concept of, 97 99 problems with convention synchronous combined, 95 97 colon resection, 25 34 complete mesocolic excision with central vascular ligation, 28 29
169 current surgical practice for, 26 how can we improve outcome of, 28 improved lymph node yield and survival, 30 31 which lymph nodes do tumors spread to, 29 30 laparoscopic, controversies in, 35 47 colon cancer, 36 38 conversion rates, 40 41 cost-effectiveness, 41 in the elderly, 41 42 learning curve for, 42 lymph node harvest, 41 obesity and, 41 pelvic nerves, 42 rectal cancer, 38 40 robotic surgery for rectal cancer, 43 single-incision laparoscopic colectomy, 43 quality assurance in surgery for, 11 23 appropriate prophylactic antibiotic use, 15 16 impact of postoperative complications, 17 18 system quality factors, 14 15 technical factors, 11 14 venous thromboembolism prevention, 16 17 Synchronous stage 4 disease, in patient with newly diagnosed colorectal cancer, 151 160 approach to stage 4 metastasis, 155 159 to liver, 155 158 to lung, 158 to peritoneum, 158 159 detecting the synchronous tumor, 152 153 need for immediate palliative surgery for primary tumor, 153 154 type and extent of metastatic disease, 154 155 T Timing of treatment, for adjuvant chemotherapy for colorectal cancer, 51 52 for surgery after neoadjuvant radiation for rectal cancer, 84 85 U Ultrasonography, endorectal (ERUS), vs. MRI in rectal cancer, 59 77 Urgency, after colorectal cancer. See Urinary dysfunction. Urinary dysfunction, after treatment of colorectal cancer, 137 139 colon cancer, 137 patient factors, 137 138 rectal cancer, 137 treatment factors, 138 139 tumor factors, 138
170 V Vascular ligation, central, with complete mesocolic excision, 28 29 Venous thromboembolism prevention, appropriate use in colon and rectal cancer surgery, 16 17