No abstract

No abstract

In this edition of the Journal of Surgical Oncology Seminars series, advances in the management of rectal cancer in the current environment of (1) minimal access surgery, (2) aggressive and innovative adjuvant therapy, (3) new advances in staging and risk stratification, (4) new tools to measure the effect of therapy on quality of life, and (5) inventive advancements in robotics and Natural Oriface Transendoscopic Surgery (NOTES) are presented by ten distinguished colleagues who have challenged conventional thinking with fresh approaches.The goals of this monograph are to chart the current and future course of minimal access surgery (laparoscopic, robotic, and NOTES), illustrate how adjuvant chemoradiation therapy has evolved and it's impact on survival, how new staging modalities and risk determination techniques will direct surgical and adjuvant care, and illustrate in what manner randomized controlled (RCT's) trials are the best mechanisms for advancing surgical innovation in patients with rectal cancer. The authors all seem to agree that the direction rectal cancer treatment will take is towards a more concrete understanding of tumor biology facilitating risk stratification, which in turn will lead to more specifically directed adjuvant and surgical management strategies so that the greatest benefit is achieved with the least impact on quality of life.Minimally invasive transanal surgery, employing transanal endoscopic microsurgery (TEM) techniques, has been used across the world for more than 15 years. It has only recently emerged, however, as an accepted means of removing rectal polyps and biopsy-proven adenocarcinomas of the rectum. The review by Ted Saclarides nicely summarizes the impact of local excision/TEM on surgery for rectal cancer, it's techniques and outcomes and focuses on the future direction of local excision in general and TEM in particular. The future of minimal access surgery is illustrated by Lee Swanstom in his fascinating discussion of NOTES and robotic techniques as applied to colorectal surgery. In addition, laparoscopic-assisted colonoscopic polypectomy, which is an interesting hybrid procedure, is described in detail.Tonia Young-Fadok makes a very strong case for aggressive use of laparoscopic techniques to resect adenocarcinoma of the colon focusing on laparoscopic-assisted colectomy, the technique, and its outcomes and comparing it to hand-assisted approaches. Her discussion very nicely indeed summarizes the five RCT's comparing LAP to open resection for colon cancer and charts the way forward for laparoscopic surgery.Minimal access surgical techniques for rectal cancer are evolving, not having been subjected to rigorous RCT's to date. Tom Read takes the reader through the development of laparoscopic approaches for rectal cancer, illustrates the technically demanding nature of laparoscopic rectal resection and makes the case that laparoscopic-assisted rectal cancer surgery will evolve rapidly by conducting clinical trials. The future importance of RCT's is well discussed in great d...