Coloproctology (eBook)

Andrew P. Zbar, Steven D. Wexner (Herausgeber)

eBook Download: PDF

2010 | 2010
XIV, 221 Seiten
Springer London (Verlag)
978-1-84882-756-1 (ISBN)

Infos

Coloproctology is a surgical specialty which dynamically changes every few years. There is a profusion of colorectal textbooks but specialty series on particularly complex topics as well as on the specialized management approach for trainees and training colorectal surgeons are actually few. The aim of this text is a superior quality colorectal book written by world experts targeted at senior surgical and colorectal trainees and young consultant coloproctologists in current areas of subspecialty expertise. The structure of the chapters is current and is based on what does not appear and is not addressed in current colorectal textbooks. This series has proven useful in areas already represented, including Neurosurgery, Vascular Surgery, Transplantation Surgery, etc. The text is aimed at being relatively didactic with an algorithm approach to specialized areas within coloproctology which could potentially be updated every 3 years or so with new topics to create a set for didactic training in colorectal surgery. It is anticipated that these texts will become valuable teaching textbooks and part of every coloproctologist's armamentarium as well as appealing to all general surgeons and surgical trainees engaged in complex elective and emergency colorectal surgery.

Andrew P. Zbar, MB BS, FRCS (Ed.), FRCS (Gen.), FRACS, FCCS Professor of General and Colorectal Surgery Queen Elizabeth Hospital Barbados 2002-PRESENT. Trained in Australia in General Surgery 1978-1993. Postgraduate colorectal work in anorectal physiology and colorectal cancer immunology and immunotherapy London Hammersmith Hospital 1993-1999. Co-Director of Coloproctology at Kaplan Hospital Tel Aviv 2000-2002. Specialist areas of interest are in functional anorectal disorders, colorectal cancer immunology and imaging of complex anorectal disorders.

Steven D Wexner, MD, FACS, FRCS, FRCSED, Chair, Advisory Council for Colon and Rectal Surgery (1998-2003), American College of Surgeons; Chair (2003), Intl Committee, Chair (2003), Intl Advisory Committee, Chair (2003), Membership Committee, Program Committee (2003), American Society for Colon and Rectal Surgeons; In 1993 helped establish the Young Surgeons Committee which offers an exchange program with the Association of Coloproctology of GB & Ireland; Ed Board of Diseases of the Colon & Rectum.

John S.P. Lumley, MS, FRCS, DMCC, FMAA(Hon), FGA, Professor of Vascular Surgery, University of London, Civilian Consultant to the Royal Navy in Vascular Surgery; Honorary Consultant Surgeon, St. Bartholomew's Hospital, London, UK

Inhalt

Foreword 6
Preface 7
Contents 8
Contributors 10
Genetic Approaches to Colorectal Cancer 12
Colorectal Cancer Epidemiology 12
Molecular Biology of Colorectal Cancer 13
Chromosomal Instability (CIN) or Tumor Suppressor Pathway 13
Microsatellite-Instability Pathway or Mutator Pathway 13
Aberrant Methylation Pathway 13
Hereditary Genetic Syndromes 14
Hereditary Non-Polyposis Colon Cancer 14
Molecular Genetics of HNPCC 15
Diagnosis of HNPCC 15
Genetic Counseling for HNPCC 17
Familial Adenomatous Polyposis 17
Molecular Genetics in FAP 18
Diagnosis of FAP 19
Genetic Counseling for FAP 20
Multivisceral Resection in Rectal Cancer 24
.Introduction 24
Preoperative Procedures 24
Staging and Imaging 24
Physical Examination 25
Radiologic Imaging 25
Neo-Adjuvant Therapy 26
Intraoperative Procedures 27
Surgical Treatment 27
Lateral Invasion 27
Posterior Invasion 27
Anterior Invasion 28
Pelvic Reconstruction 28
Intraoperative Decisions 29
Intraoperative Radiation Therapy (IORT) 29
Morbidity of Multivisceral Resection 29
Colonic Stenting 32
.Introduction 32
.SEMS: Types 33
Placement 33
Radiological Placement 33
Endoscopic/Fluoroscopic Placement 34
Efficacy 34
Safety 34
Covered Vs. Uncovered Stents 35
Costs 35
Discussion 35
Chemotherapy Trials for Colorectal Cancer in Advanced Disease: What’s the Current Hypothesis? 37
Introduction 37
5-Fluorouracil 38
Capecitabine 38
Irinotecan 39
Oxaliplatin 40
What Is the Optimal Sequence of Cytotoxics? 40
Is Response Rate Important? 41
Continuous vs. Intermittent Therapy 44
Bevacizumab 46
The CONcePT Trial (Grothey et al. .2008b., ASCO 4010) 50
Cetuximab 50
Results of First-Line Trials 51
Second-Line Trials 52
Panitumumab 54
Studies with Two Targeted Agents Combined 55
Neo-Adjuvant (Metastatic) 56
Third-Line Studies 58
Conclusion 59
Current Clinical Trials in Radiotherapy for Rectal Cancer 65
.Work-Up of Patients with Rectal Cancer 65
.Staging 66
.Prognosis 66
.Adjuvant Therapy 66
Adjuvant Postoperative Radiotherapy Without Chemotherapy 68
Intensive Short Course Preoperative Radiotherapy Without Chemotherapy 69
Preoperative (Neoadjuvant) Chemoradiotherapy 69
Postoperative Chemoradiotherapy 70
Postoperative Adjuvant Chemotherapy Without Radiation 70
Treatment of Locally Advanced Unresectable Rectal Cancer 71
Radiation Therapy Simulation and Field Arrangement 71
Current Dose and Fractionation at Kaiser Permanente, Southern California 72
Acute Side Effects and Complications of Combined Modality Treatment 73
Chronic Effects of Radiotherapy on Anal and Bowel Functions 73
Long-Term Follow-Up 74
Quality of Life Issues and Rectal Cancer 78
Introduction 78
Effect of Surgery and Radiation on Function 78
Health-Related Quality of Life (HRQOL) 80
Quality of Life and Surgery 82
Quality of Life and Radiotherapy 84
Quality of Life and Long-Term Follow-Up and Recurrence of Rectal Cancer 85
Conclusion 85
Managing Presacral Tumors 89
Presacral Tumors: General Considerations 89
Specific Presacral Tumors 90
Sacral Chordomas 90
Tailgut Cysts 92
Dermoid and Epidermoid Cysts 94
Rectal Duplication Cysts 94
Anterior Sacral Meningocele 95
Schwannomas 95
Teratomas 96
Miscellaneous Tumors 96
Conclusion 96
Revisional Pouch Surgery 100
Sepsis 101
Early Sepsis 101
Management 101
Delayed Sepsis 102
Management 102
Summary 103
Fistulation into the Vagina 104
Management 104
Summary 107
Poor Function 107
Differential Diagnosis 107
Mechanical Outlet Obstruction 108
Long Efferent Limb 108
Stricture of the Ileoanal Anastomosis 109
Retained Rectum After Ileorectal Anastomosis 110
Summary 111
Small-Volume Reservoir 111
Sphincter Dysfunction 111
Pouchitis 112
Conclusion 112
Surgery for Fecal Incontinence 116
Introduction 116
Diagnostics and Treatment Considerations 116
Functional Rehabilitation 117
Biofeedback 117
Sacral Nerve Stimulation 118
Reconstructive Techniques 119
Bioinjectables 119
Sphincter Repair 120
Sphincter Replacement 121
Dynamic Graciloplasty 121
Artificial Bowel Sphincter 121
Antegrade Continence Enema (ACE) 123
Stoma Creation 123
Summary 123
Recurrent Rectal Cancer 127
Introduction 127
Incidence 127
Surveillance Following Primary Therapy 128
Diagnosis of Recurrence 128
Radiographic Studies 129
Patterns of Recurrence 131
Surgical Management 132
Determination of Resectability 132
Pelvic Exenteration 133
Combined Sacrectomy with Exenteration 134
Laparoscopic Surgery 137
Palliative Surgery 137
Use of Intraoperative Radiation Therapy 138
Perineal Reconstruction 139
Nonoperative Management 142
Summary 142
The Surgical Management of Evacutory Dysfunction 145
Introduction 145
Patient Evaluation 145
Physical Examination 146
Diagnostic Testing 146
Rectocele 147
Enterocele 148
Sigmoidocele 148
Rectal Anal Intussusceptions and Rectal Prolapse 149
Puborectalis syndrome 150
Megarectum 150
Sacral Nerve Stimulation for Constipation 151
Antegrade Colonic Enema 151
Fecal Diversion 152
New Approaches in Perineal Crohn’s Disease 155
Introduction 155
Classification 155
Diagnosis 157
Medical Management 157
Surgical Management 158
Conclusion 163
Complex Anal Fistula 167
Introduction 167
Definitions and Classifications 167
Intersphincteric Fistula (Fig. .13.1a.) 168
Trans-sphincteric Fistula (Fig. .13.1b.) 168
Suprasphincteric Fistula (Fig. .13.1c.) 169
Extrasphincteric Fistula (Fig. .13.1d.) 169
Prevalence 169
Etiology 169
Clinical Presentation and Evaluation 169
Procedure Options 171
Fistulotomy 171
Fistulectomy 171
Setons 171
Advancement Rectal Flaps 172
Fibrin Glue Injection and Fistula Plug 173
Colostomy 173
Crohn’s Disease 173
Summary 174
Rectovaginal and Rectourethral Fistula 175
Introduction 175
Rectovaginal Fistula 175
Presentation and Investigation 175
Classification 176
Etiology 176
Trauma 176
Inflammatory Bowel Disease 177
Malignant Fistulas 177
Pelvic Radiation 177
Management 178
Local Repairs 178
Simple Fistulas 178
Crohn’s Disease 180
Trans-Abdominal Approaches 181
Radiation-Induced Fistula 181
Malignant Fistula 182
Bulbocavernosus (Martius) Graft 182
Diverting Stoma 183
Recurrent Fistulas 183
Rectourethral Fistula 184
Presentation and Investigation 184
Management 184
Local Techniques 185
Abdominal Approaches 185
Omental and Muscle Interposition 185
Conclusion 186
Surgeon-Performed Ultrasound in Proctologic Practice 191
Introduction 191
Complex Perirectal Sepsis 192
Fecal Incontinence 194
Evacuatory Dysfunction and Other Functional Problems 196
Miscellaneous including Anal and Rectal Tumors 199
Changing Paradigms in the Treatment of Sigmoid Diverticulitis 208
Background/Historical Perspective 208
Diagnosis and Initial Treatment of Uncomplicated Diverticulitis 209
Risk of Subsequent Attacks of Diverticulitis After Recovery from Uncomplicated Diverticulitis 211
Risk of Developing Complications After Recovery from an Attack of Uncomplicated Diverticulitis 211
Severity of Disease 212
Young Patients and Diverticulitis 212
Complicated Diverticulitis 212
Diverticular Abscess 213
Perforated Diverticulitis 214
Diverticular Fistulas 214
Obstruction 215
Immunocompromised Patients 215
Technical Aspects of Surgery for Diverticular Disease 216
Determination of 1 or 2 Stage Procedures 216
Laparoscopic Surgery 217
Conclusion 218
Index 221

Produkt-Details

• Erscheint lt. Verlag: 18.1.2010
• Reihe/Serie: Springer Specialist Surgery Series
• Reihe/Serie: Springer Specialist Surgery Series
• Zusatzinfo: XIV, 221 p. 56 illus., 24 illus. in color.
• Verlagsort: London
• Sprache: englisch
• Themenwelt: Medizinische Fachgebiete ► Chirurgie ► Viszeralchirurgie
• Themenwelt: Medizin / Pharmazie ► Medizinische Fachgebiete ► Gynäkologie / Geburtshilfe
• Themenwelt: Medizin / Pharmazie ► Medizinische Fachgebiete ► Innere Medizin
• Themenwelt: Medizin / Pharmazie ► Medizinische Fachgebiete ► Onkologie
• Schlagworte: Cancer • Coloproctology • Colorectal Cancer • Colorectal Surgery • incontinence • neurosurgery • Surgery • Transplantation • Tumor • Ultrasound • vascular surgery
• ISBN-10: 1-84882-756-3 / 1848827563
• ISBN-13: 978-1-84882-756-1 / 9781848827561