Twenty years ago rectal cancer was treated almost exclusively by surgery. This often took the form of total rectal excision resulting in a permanent colostomy. The quality of surgery was variable and the results were often unknown. The last 20 years have seen a remarkable transition due to various factors. Perhaps the most important was the gradual recognition that local recurrence was the appropriate end-point for local and regional treatments such as surgery and radiotherapy. Risk factors for local recurrence became identified by histopathologists and these began to be identified pre-operatively, initially by clinical examination and subsequently by imaging.
Computerised tomography, endorectal ultrasound and magnetic resonance are now capable of anticipating the pathology with sufficient accuracy to identify the degree of risk of local recurrence before treatment. This has allowed the rational development of management strategies whether they include neoadjuvant chemoradiotherapy or less invasive surgery such as local excision. Improved staging has also been at the centre of the move from excisional to restorative major surgery, with total mesorectal excision inspiring more careful dissection mindful of the locoregional pathology. While survival and freedom from local recurrence are the main end-points of treatment, function has become increasingly important as part of the measure of quality of life.
In Rectal Cancer: New Frontiers in Diagnosis, Treatment and Rehabilitation, all these developments are dealt with by expert authors. The editing has been uniform to create a balanced account of the areas of importance in rectal cancer as treated today. The references in each chapter are numerous and up-to-date and will be a valuable resource to the reader. There are chapters on surgical technique and choice of operation, which summarise with authority the present state of knowledge. Staging and multimodality treatment including the management of stage IV disease are dealt with in detail. Techniques to improve function by providing continence after removal of the anal sphincter and colonic reservoirs are also reviewed.
Taken as a whole, Rectal Cancer is an informative and accurate summary of the present position. It has focused on the areas of development and contention. The book will be a very useful contribution to the knowledge of trained practitioners and trainees alike.
R. John Nicholls
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