Laparoscopic and Robotically Assisted Proctectomy
Fig. 14.1 Five-year overall survival by actual procedure for all patients randomized by surgeons with a lower than average conversion rate (log rank test): p = 0.013 (Wilcoxon test) (From Jayne et…
Total Mesorectal Excision with Autonomic Nerve Preservation: “Optimized Surgery”
Fig. 12.1 The correct plane in total mesorectal excision TME is associated with improved local control and survival rates. The local recurrence rate following total mesenteric excision with an APR…
Surgical Approach to Locally Recurrent Disease
Fig. 19.1 CT 3-dimensional system to evaluate pattern of recurrence (With kind permission from Springer Science + Business Media: Höcht et al. [21], p. 110) Magnetic resonance imaging (MRI) is…
Lateral Lymph Node Dissection for Rectal Cancer
Fig. 13.1 Lateral lymph nodes (yellow circles) defined by the Japanese Classification of Colorectal Carcinoma. Internal iliac nodes, common iliac nodes, obturator nodes and external iliac nodes constitute the lateral…
The Role of Imaging in the Diagnosis and Staging of Primary and Recurrent Rectal Cancer
Fig. 6.1 Mid rectal annular tumour spreads beyond the muscularis propria up to 8 mm (a– yellow arrows). Mesorectal fascia (b – red line, which defines the mesorectum) is involved…
Restorative Proctectomy and Colonic Reservoirs
Modified lithotomy position Digital rectal examination to assess level of tumor in relation to dentate line and fixation of tumor Laparoscopic approach unless contraindicated Complete mobilization of left colon Identification…
Complications of Rectal Cancer Surgery
Fig. 29.1 Deep pelvic dissection anatomy Bleeding Hemorrhage can occur suddenly when the presacral fascia is breached and pelvic veins are injured. Manual pressure or suture ligation can curtail most…
Abdominoperineal Resection
Fig. 11.1 (a) Plane of resection utilized when TME plane is followed to its termination. A waist is produced at the level of the puborectalis. (b) Plane of resection when…
Local Excision of Rectal Cancer
High risk Low risk Poor differentiation Well and moderate differentiation Size ≥3 cm Size <3 cm Circumferential involvement ≥30 % of lumen Circumferential involvement <30 % of lumen Presence of…
Anatomy and Physiology of the Rectum and Anus
Fig. 3.1 Embryonal development of the cloaca (Reproduced from Schunke M, et al. Promethius LernAtlas der Anatomie, vol. 2. 3rd ed. Stuttgart: Thieme Publ.; 2012, with permission) At this point…
