Neoplasms of the Colon, Rectum, and Anus, Second Edition > General Surgery

Synopsis
Colorectal cancer is the second-leading cause of cancer-related death in the Western World. This Second Edition
analyzes the genetics, mechanisms, and development of colorectal carcinoma and supplies the latest research and
recommendations on the detection, treatment, and prevention of malignancies of the colon, rectum, and anus.
Doody Review Services
Reviewer:Neal Wilkinson, MD(University of Iowa Hospitals and Clinics)
Description:All aspects of colorectal cancer are covered in complete detail in this book. The material is drawn from
the comprehensive text Principles and Practice of Surgery for the Colon, Rectum, and Anus by the same authors (informa
Healthcare/Taylor & Francis, 2007).
Purpose:The authors' stated purpose is to summarize the body of knowledge pertaining to colorectal neoplasms in a
focused and direct book. Readers are presented with pertinent background, adequate detail, and current references.
Audience:The book is directed at a surgical audience. Surgeons in training will find the excellent text diagrams
extremely helpful. For fellowship trained surgical oncologists and colorectal specialists, the book provides an up-to-
date, focused reference.
Features:Large sections cover colon, rectal, and anorectal disorders. Each section is subdivided into pathology,
diagnostics, and treatment. This well written book includes numerous summary tables and current references. Figures and
pictures (color) are well selected and complement the text. The index and table of contents are excellent, especially
for locating specific topics.
Assessment:There is little redundancy or variability between chapters. Each section is equally well written by senior
and experienced surgeons. The selected surgical techniques and diagrams are educational and provide various options for
different situations.

Table of Contents
Dedication iii
Preface v
Colorectal Disorders
Benign Neoplasms of the Colon and Rectum Santhat Nivatvongs 1
Polyps of Colon and Rectum 2
Familial Adenomatous Polyposis 16
Hemangiomas of Large Bowel 30
Leiomyomas of Large Bowel 31
Lipomas of Large Bowel 32
References 33
Large Bowel Carcinoma: Screening, Surveillance, and Follow-Up Santhat Nivatvongs 39
Detection of Early Colorectal Carcinoma 39
Early Diagnosis of Colorectal Carcinoma 40
What Is Screening? 40
Who Should Be Screened? 40
Screening People at Average Risk for Colorectal Carcinoma 41
Screening People at Increased Risk for Colorectal Carcinoma 43
New Screening Tests 44
When to Stop Screening 44
Surveillance 45
Follow-Up after Curative Resection 46
Other Primary Malignancies 47
Summary 47
References 48
Malignant Neoplasms of the Colon Philip H. Gordon 51
Classification 52
Adenocarcinoma 52
Incidence, Prevalence, and Trends 52
Epidemiology 53
Age 53
Sex 53
Family History 53
Site 54
Geographic Distribution 54
Race and Religion 54
Occupation 54
Etiology and Pathogenesis 55
Polyp-Cancer Sequence 55
Inflammatory Bowel Disease 55
Genetics 55
Dietary Factors 72
Irradiation 77
Ureteric Implantation 77
Cholecystectomy 78
Diverticular Disease 78
Activity and Exercise 78
Other Factors 79
Juvenile vs. Adult Carcinoma 80
Prospects for Prevention 81
Pathology 82
Macroscopic Appearance 82
Microscopic Appearance 83
Depressed Carcinoma 85
Sentinel Lymph Node Mapping 87
Modes of Spread 88
Site of Spread 89
Staging 89
Biology of Growth 92
Clinical Features 94
Symptoms 94
General and Abdominal Examinations 95
Digital Rectal Examination 95
Extraintestinal Manifestations 95
Synchronous Carcinomas 95
Associated Polyps 95
Other Associated Malignancies 96
Complications 96
Obstruction 96
Perforation 97
Bleeding 97
Unusual Infections Associated with Colorectal Carcinoma 97
Diagnosis 97
Investigations 98
Occult Blood Testing 98
Endoscopy 98
Radiology 98
Radioimmunodetection 101
Cytology 102
Blood Markers 102
Treatment 104
Curative Resection 104
Adjuvant Therapy 117
Complicated Carcinomas 123
Perforation 128
Bleeding 128
Obstructive Colitis 128
Invasion of Adjacent Viscera 129
Urinary Tract Involvement by Colorectal Carcinoma 131
Primary Involvement of the Urinary Tract 131
Bladder Involvement 132
Ureteric Involvement 132
Fistula 132
Hydronephrosis 133
Radiotherapy 133
Unexpected Intraoperative Involvement 133
Recurrent Colorectal Carcinoma 133
Abnormal Renal Function 133
Palliation 133
Unresectable Carcinoma 153
Palliative Resection 133
Synchronous Carcinomas 134
Synchronous Polyps and Carcinoma 134
Metachronous Carcinoma 134
Treatment of Metastatic Disease 135
Carcinoma in Young Patients 147
Postoperative Complications 147
Results 148
Prognostic Discriminants 152
Clinical Features 152
Pathologic Features 160
Biochemical and Special Investigations 164
Recurrent Disease 166
Follow-Up 166
Incidence 166
Contributing Factors 166
Patterns 167
Clinical Features 168
Investigations 168
Rote of Carcinoembryonic Antigen 169
Treatment 170
Results of Reoperation 175
Intestinal Obstruction Due to Recurrent Carcinoma 175
Colorectal Carcinoma Complicating Pregnancy 176
Ovarian Carcinoma Involving the Colon 177
Malakoplakia and Colorectal Carcinoma 177
Other Malignant Lesions 177
Carcinoid 177
Incidence 178
Clinical Features 178
Pathology 178
Imaging Procedures 179
Chemical Activity 179
Treatment 180
Results 180
Lymphoma 180
Incidence 180
Pathology 180
Clinical Features 181
Treatment 182
Results 182
Sarcoma 182
Squamous Cell Carcinoma 183
Adenosquamous Carcinoma 184
Plasmacytoma 184
Melanoma 184
Leukemic Infiltration 185
Neuroendocrine Lesions of the Colorectum 185
Medullary Carcinoma of the Colon 185
Carcinosarcoma 186
Schwannoma 186
Angiosarcoma 186
Choriocarcinoma 186
Metastases from Other Sources 187
References 187
Malignant Neoplasms of the Rectum Philip H. Gordon 207
Adenocarcinoma 208
Mechanisms of Spread of Rectal Carcinoma 208
Direct Extension 208
Transperitoneal Spread 208
Implantation 208
Lymphatic Spread 208
Venous Spread 208
Clinical Features 209
Symptoms 209
General and Abdominal Examination 209
Investigations 209
Endoscopy 209
Routine Laboratory Blood Work 209
Radiology 209
Preoperative Preparation 223
Radical Extirpative Operations 224
Assessment of Resectability 214
Selection of Appropriate Operation 214
Operative Procedures 216
Postoperative Care 236
Results 236
Local Forms of Therapy 245
Rationale 245
Procedures 245
Special Considerations 253
Distal Margins 253
Circumferential Margins 254
Total Mesorectal Excision 254
Radical Lymphadenectomy 258
Concomitant Pelvic Organ Excision 260
Palliative Therapy for Advanced Rectal Carcinoma 261
Hartmann's Procedure 264
Unresectable Carcinoma of the Rectum 264
High Ligation of Inferior Mesenteric Artery 265
Marking the Rectum 265
Adjuvant Therapy for Carcinoma of the Rectum 266
Radiotherapy 266
Chemotherapy 274
Combination Chemoradiotherapy 274
Immunotherapy 279
Summary 280
Postoperative Complications 280
Recurrent Disease 280
Follow-up 280
Incidence 280
Factors Contributing to Recurrence 281
Patterns of Recurrence 281
Clinical Features 282
Investigations 282
Treatment of Recurrent Disease 283
Results of Reoperation 290
Other Malignant Lesions of the Rectum 290
Carcinoid 290
Clinical Presentation 291
Investigation 291
Pathology 291
Treatment 291
Results 291
Lymphoma 292
Clinical Presentation 292
Treatment and Results 292
Sarcoma 292
Gastrointestinal Stromal Tumor (GIST) 293
Secondary Carcinoma 294
Miscellaneous Neoplasms 294
References 234
Anorectal Disorders
Perianal and Anal Canal Neoplasms Santhat Nivatvongs 305
Introduction 305
Anatomic Landmarks 305
Incidence 306
Etiology and Pathogenesis 306
Staging 307
Screening for Anal Carcinoma Precursors 307
Human Papilloma Virus Type 16 Vaccine 307
Perianal Neoplasms (Anal Margin) 309
Neoplasms of the Anal Canal 315
References 324
Transanal Techniques Santhat Nivatvongs 327
Introduction 327
Rectal Biopsy 327
Electrocoagulation of Rectal Polyps 328
Snare Polypectomy 328
Transanal Excision of Rectal Adenoma 328
Transanal Excision for Carcinoma of the Low Rectum 332
Posterior Approach to the Rectum 332
Transanal Endoscopic Microsurgery 335
Electrocoagulation of Carcinoma of the Rectum 337
References 338
Minimally Invasive Surgery
Laparoscopic Colon and Rectal Surgery Lee E. Smith Philip H. Gordon 341
Background and Rationale 342
Indications 345
Equipment and Instrumentation 344
Operative Procedure 348
Specific Colorectal Procedures 353
Robotics 363
Postoperative Care 364
Results 364
Laparoscopic Complications and Their Prevention 383
References 387
Index 391

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