How to Test QoL

In the recent past, there was diffuse scepticism among researchers on using QoL tests in their trials or a trend towards using non-standardised questionnaires 14 . The former is due to the high number of methods for testing QoL by interviews (structured, semi-structured, non-structured), by questionnaires (standardised, non-standardised) and by ad hoc questions. Theoretically speaking, most of them can be easily and efficiently used in clinical practice but as already explained, cannot be...

Stage uT0 Villous Adenoma

Sonographic evaluation of a villous rectal lesion is helpful in determining the presence of tumour invasion. The presence of an intact hyperechoic submu-cosal interface indicates lack of tumour invasion into the submucosa. Heintz et al. 4 believe that ERUS cannot differentiate between villous adenoma and invasive cancers because neither the muscolaris mucosae nor the submucosa is sonographically definable and the first hypoechoic layer corresponds anatomically with the mucosa and the submucosa....

Spirio And Virgo Relationship

Pfister DG, Horwitz RI (1987) The rightward shift of colon cancer. Aging or artifact J Clin Gastroenterol 9 58-61 2. Nelson RL (1998) Division of the colorectum into anatomic subsites why and where J Surg Oncol 69 1-3 3. Parkin DM, Pisani P, Ferlay J (1999) Global cancer statistics. CA Cancer J Clin 49 33-64 4. Nakaji S, Umeda T, Shimoyama T et al (2003) Environmental factors affect colon carcinoma and rectal carcinoma in men and women differently. Int J Colorectal Dis 18 481-486 5. Gatta G,...

Post Operative Radiation Therapy

In our institution, we rarely perform post-operative radiation therapy, which is frequently associated with 5-fluorouracil (5-FU)-based chemotherapy and is delivered when the surgical specimen of a good patient selected for exclusive surgery shows risks of local recurrence such as incomplete tumour resection as well as nodal disease involvement. Post-operative radiotherapy has shown the advantage of being selectively delivered in patients at high risk of local recurrence as well as the...

Contents

Epidemiology and Burden of Disease Stefano Tardivo, William Mantovani, Emanuele Torri, Albino Poli 1 Diagnostic Imaging Diagnosis and Staging Riccardo Manfredi, Giulia Zamboni, Giovanni Carbognin, Farah Moore, Rossella Pre-Operative Staging Endorectal Ultrasound Giulio Aniello Santoro, Carlo Predictive Markers in Physiology and Anatomy for Outcomes in Rectal Cancer Patients Johann Rectal Cancer Pathological Features and their Relationship to Prognosis and Treatment Paola Capelli,...

References

Parkin DM, Bray F, Ferlay J, Pisani P (2005) Global cancer statistics, 2002. CA Cancer J Clin 55 74-108 2. Miles WE (1908) Method for performing abdomin-operineal excision for carcinoma of the rectum and the terminal portion of the pelvic colon. Lancet 2 1812-1813 3. Dixon CF (1939) Surgical removal of lesions occurring in the sigmoid or the rectosigmoid. Am J Surg 46 12-17 4. Heald RJ (1988) The 'Holy Plane' of rectal surgery. J R Soc Med 81 503-508 5. Szczepkowski M (2002) Do we still need a...

Indications and Contraindications in Surgical Therapy

The indications for resection of hepatic metastases are obtained from the analysis of the prognostic elements described above. The pre-operative evaluation of the patient should consider general examinations for abdominal general surgery and evaluation of liver function 36 . In patients with normal liver function, resections of 70-80 of the total hepatic mass can be safely performed. In patients submitted to per-oper-ative chemotherapy or with chronic liver disease, resection should be limited...

Materials and Methods

Between 1999 and 2003 we carried out a total anorectal reconstruction (TAR) in 12 patients previously operated on with an APR by performing a perineal colostomy and placing an artificial bowel sphincter around the perineal stoma 20, 21 . This procedure was performed by three surgeons in different institutions according to a common protocol. Ten patients had been operated on for rectal cancer, one had had a colostomy in childhood for rectal agenesia and one patient had been treated with a Miles...

Stage uT2 Invasion of the Muscular Layer

Sonographic diagnosis of tumour invasion of the muscolaris propria is based on thickening of this layer (Fig. 13). The muscolaris propria is represented by a thin hypoechoic layer adjacent to the hypere-choic submucosal interface. As the tumour is also hypoechoic, early muscular invasion is difficult to Fig. 13a, b. uT2 rectal tumour in 2D (a) and 3D (b) Fig. 13a, b. uT2 rectal tumour in 2D (a) and 3D (b) Fig. 14a, b. uT3 rectal tumour in 2D (a) and 3D (b) Fig. 14a, b. uT3 rectal tumour in 2D...

Avoidable Risk Factors

A comparison of CRC rates in different countries shows great variation. And time trends within some countries are also notable. Dietary, lifestyle and environmental factors but not racial, ethnical or genetic factors seem to account for a great part of the differences in incidence. Some of the most striking, rapid and well documented changes in diet were seen in Japan 93 . Consumption of meat and dairy products increased between the 1950s and 1990s and thus the rate of CRC 4 . Changes in food...

Non Avoidable Risk Factors

Certain differences in sex incidence emerge when carcinomas are assessed separately for the large bewed. Right colon lesions have been observed to be more common in women while men seem to be at higher risk for rectal cancer. The prevalence of colon cancer has a ratio of females males equal to 1.2 1, and rectal cancer a ratio of males females equal to 1.4 1. Right colon cancers have been shown to account for a greater percentage of colorectal neoplasms in older patients while left colon and...

Stage uT1 Submucosal Invasion

Haggitt Levels

If a tumour arises in a polyp it is important to determine whether the stalk is invaded. Differences in classification are reported between Western and Japanese pathologists. In 1985 Haggitt et al. 6 divid Fig. 9. uT0 rectal tumour (villous adenoma) in 2D (a) and 3D (b) Fig. 9. uT0 rectal tumour (villous adenoma) in 2D (a) and 3D (b) Fig. 10. Level of submucosal invasion according to Haggitt's Fig. 11. Level of submucosal invasion according to the classification Japanese classification Fig. 10....

Early and Late Complications After LAR

Anastomotic leakage has always been a major clinical problem in rectal or anal anastomosis, however this complication after LAR still remains a challenging clinical problem that can lead to significant morbidity and mortality. The use of stapling devices, performing mid and low rectal cancer resections with TME that require radical dissection may lead to a higher rate of anastomotic leakage. The reported clinical leakage rate after anterior resection varies from 3 to 21 depending on the level...

Rectal Anatomy

The analysis of the anatomy of the distal portion of the large intestine and of the sigmoid colon at the level of the third sacral vertebra is continuous with the distal portion of the large intestine the rectum. The longitudinal musculature that at the colonic level is arranged in three bands, the taeniae, at the colorectal junction expands again to form a continuous layer of longitudinal musculature 1 . The haus-tra disappear and the distal portion of the intestine appears as a smooth, almost...