Table Of ContentRecent Results 146
in Cancer Research
Managing Editors
P. M. Schlag, Berlin· H.-J. Senn, St. Gallen
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P. M. Schlag (Ed.)
Rectal Cancer
Surgical Management, Basic and Clinical Research
With 66 Figures, some in Color and 41 Tables
Springer
Prof Dr. med. Peter M. Schlag
Klinik fur Chirurgie und Chirurgische Onkologie
Universitatsklinikum Charite, Robert-Rossle-Klinik
Lindenberger Weg 80, D-13125 Berlin
ISBN-13: 978-3-642-71969-1 e-ISBN-13: 978-3-642-71967-7
DOl: 10.1007/978-3-642-71967-7
ISSN 0080-0015
Library of Congress Cataloging-in-Publication Data applied for
Rectal cancer: surgical management, basic and clinical research 1 P. M. Schlag (ed.). (Re
cent results in cancer research, ISSN 0080-0015; 146) Includes bibliographical references
and index. I. Rectum-Cancer. 2. Rec- tum-Cancer-Surgery.
l. Schlag, P. M. (Peter), 1948- . II. Series. [DNLM: I. Rectal
Neoplasms-surgery. WI REI06P v. 146 1998 1 WI 610 R312 1998J RC280.R35 vol.
146 [RC280.R37J 616.99'435-dc21 DNLM/DLC for Library of Congress
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Preface
Rectal cancer is an exceptional tumour entity within the variety
of gastrointestinal tumours. While clinical techniques such as
rectal digital examination and endoscopy would enable diagnosis
as early as the stage of polypoid preneoplasia, only 10% of rectal
cancer patients undergo surgery at an early stage of the disease.
The prognosis of rectal cancer without infiltration of the muscu
laris is relatively good. However, with locally more advanced tu
mours, possibly associated with lymphnode metastases, the prob
ability of successful treatment decreases considerably. Further
more, there is a clear prognostic discrepancy between proximal
and distal rectal cancers. Rectal carcinomas, especially in the dis
tal location, except those diagnosed at an early stage, usually re
quire surgical treatment with postoperatively disturbed or lost
anal sphincter function. A permanent colostomy may not be
avoidable. The current trends and developments in diagnosis and
therapy of rectal cancers may be described as follows:
• The search for new diagnostic procedures and the attempt to
define risk groups for which intensive preventive measures
would be clearly successful. New insights may come from mod
ern molecular biology or molecular genetics, especially with re
gard to hereditary colorectal carcinoma.
• A further increase in the rate of sphincter-preserving surgery
without impairment of local tumour control or overall prog
nosis. New surgical techniques such as trans sphincteric resec
tion, but also various multimodal local treatment regimens,
especially for low-risk tumours, are promising approaches.
However, exact preoperative staging is an essential precondi
tion for such procedures. Sphincter replacement or sphincter
simulating surgical treatments might be an alternative.
• The search for therapeutic improvement in locally advanced tu
mours. A reduction in the local recurrence rate should improve
the patient's prognosis as a whole. This will be achieved by
multimodal therapy concepts, focusing currently on preopera-
VI Preface
tive radio chemotherapy, sometimes in combination with hyper
thermia.
This book constitutes a topical report on the above-mentioned
themes and demonstrates current solutions. It is based upon an
international expert conference and summarises the individual
experiences of the participants as much as current general
knowledge. The major aim of this work is to contribute to the
ongoing discussion and to stimulate substantially further devel
opment in the field.
Berlin, Apri11998 P.M. Schlag
Contents
Molecular Biology of Rectal Cancer
Molecular Pathology of Colorectal Cancer:
From Phenotype to Genotype . . . . . . . . . . . . . . . . . . . . . . . 3
M. Dietel
Familial and Hereditary Non-polyposis Colorectal Cancer:
Issues Relevant for Surgical Practice ..................... 20
F. H. Menko, J. T. Wijnen, H. F. A. Vasen, R. H. Sijmons,
P.M. Khan
Staging and Prognostic Markers
Use and Applications of MRI Techniques in the Diagnosis
and Staging of Rectal Lesions ......................... 35
T.J. Vogl, W. Pegios, M. Hunerbein, M. G. Mack,
P. M. Schlag, and R. Felix
The Value of Tumor Markers in Colorectal Cancer 48
M. Hunerbein
Surgical Strategy
Possibilities of Extensive Surgery ....................... 59
W. Hohenberger, K. E. Matzel, and U. Stadelmeier
Total Mesorectal Excision for Cancer of the Rectum 66
P. Aeberhard and F. Fasolini
Radical Surgery for Extensive Rectal Cancer: Is It Worthwhile? 71
F. L. Moffat, Jr., and R. E. Falk
VIII Contents
Sphincter Preservation and Sphincter Reconstruction
Coloanal Houch Reconstruction Following Low Rectal Resection 87
K.-H. Fuchs, M. Sailer, M. Kraemer, and A. Thiede
Seromuscular Spiral Cuff Perineal Colostomy: An Alternative
to Abdominal Wall Colostomy After Abdominoperineal Excision
for Rectal Cancer . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. 95
P. M. Schlag, W Slisow, and K. T. Moesta
Total Anorectal Reconstruction Supported
by Electrostimulated Gracilis Neosphincter ................. 104
E. Cavina, M. Seccia, and M. Chiarugi
Local Excision of Rectal Cancer Through Windowed Specula:
Long-Term Results . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. 114
W Slisow, K. T. Moesta, and P. M. Schlag
Prevention of Local Recurrence
Locoregional Recurrence of Rectal Cancer:
Biological and Technical Aspects of Surgical Failure ........... 127
P. Hohenberger
Radiochemotherapy as an Adjuvant Treatment for Rectal Cancer .. 141
L. Ptzhlman
Intraoperative Radiotherapy as Adjuvant Treatment
for Stage II/III Rectal Carcinoma ........................ 152
M.]. Eble, T. Lehnert, C. Herfarth, and M. Wannenmacher
Radical Sphincter Preservation Surgery with Coloanal Anastomosis
Following High-Dose External Irradiation
for the Very Low Lying Rectal Cancer .................... 161
G.J. Marks, J.H. Marks, M. Mohiuddin, and L. Brady
Radiochemotherapy and Hyperthermia in the Treatment
of Rectal Cancer .................................. 175
P. Wust, B. Rau, J. Gel/ermann, W Pegios, ]. Loffel,
H. Riess, R. Felix, and P. M. Schlag
Contents IX
Future Strategies to Improve Results of Therapy
Dietary and Chemopreventive Strategies 195
R. W. Owen
Diagnosis and Therapeutic Relevance of Micrometastases ........ 214
E. Hoiz, K. Pantel, and C. Riethmuller
Subject Index .................................... 219
List of Contributors *
Aeberhard, p.66 Menko, F. H. 20
Brady, L. 161 Moesta, K. T. 95, 114
Cavina, E.104 Moffat, F. L. Jr. 71
Chiarugi, M.104 Mohiuddin, M.161
Dietel, M.3 Owen, R. W.195
Eble, M. J. 152 Piihlman, L. 141
Falk, R. E. 71 Pantel, K.214
Fasolini, F. 66 Pegios, W.35, 175
Felix, R.35, 175 Rau, B.175
Fuchs, K.-H, 87 Riess, H. 175
Gellermann, J.175 Riethmiiller, G.214
Herfarth, C. 152 Sailer, M.87
Hohenberger, p.127 Schlag, P. M. 35, 95, 114, 175
Hohenberger, W.59 Seccia, M.104
Holz, E.214 Sijmons, R. H. 20
Hiinerbein, M.35, 48 Slisow, W.95, 114
Khan, P. M. 20 Stadelmeier, U. 59
Kraemer, M.87 Thiede, A.87
Lehnert, T.152 Vas en, H. F. A. 20
LOffel, J. 175 Vogl, T. J. 35
Mack, M. G. 35 Wannenmacher, M.152
Marks, G. J. 161 Wijnen, J. T. 20
Marks, J. H. 161 Wust, p.175
Matzel, K. E. 59
* The address of the principal author is given on the first page
of each contribution.
I Page on which contribution begins.
