Oncologic Outcomes

  • Joel E. Goldberg
  • Ronald Bleday


Colon and rectal cancer is a major health problem in industrialized societies. In the USA alone there are approximately 145,000 new cases of colorectal cancer per year and approximately 42,000 of these patients are diagnosed with rectal cancer. Moreover, colon and rectal cancer is the third most common cancer diagnosis and the second leading cause of cancer death in both men and women in North America. In fact, 40,000–50,000 deaths can be attributed to colon and rectal cancer each year in the USA alone [1, 2]. A new diagnosis of rectal cancer is very worrisome for many patients because of the need for radical surgery and its potential side effects and consequences. Alterations in bowel and bladder function, sexual dysfunction and, most importantly, the possibility of radical surgery resulting in the need for a permanent colostomy all weigh heavily on the minds of patients diagnosed with rectal cancer.

Locally advanced tumors of the mid and distal rectum (stage II and III...


Rectal Cancer Total Mesorectal Excision Local Excision Local Recurrence Rate Transanal Endoscopic Microsurgery 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.


  1. 1.
    Cancer Facts and Statistics 2004. Atlanta: American Cancer Society.Google Scholar
  2. 2.
    Jemal A, Murray T, Samuela A, et al. Cancer statistics, 2003. CA Cancer J Clin 2003;53:5.CrossRefPubMedGoogle Scholar
  3. 3.
    Heald RJ, Moran BJ, Ryall, RD, et al. Rectal cancer: The Basingstoke experience of total mesorectal excision, 1978–1997. Arch Surg 1998;133:894–899.CrossRefPubMedGoogle Scholar
  4. 4.
    Kapiteijn E, Marijnen CA, Nagtegaal ID, et al. Preoperative radiotherapy combined with total mesorectal excision for resectable rectal cancer. N Engl J Med 2001;345(9):638–646.CrossRefPubMedGoogle Scholar
  5. 5.
    Sauer R, Becker H, Hohenberger W, et al. Preoperative versus postoperative chemoradiotherapy for rectal cancer. N Engl J Med 2004;351(17):1731–1740.CrossRefPubMedGoogle Scholar
  6. 6.
    Blumberg D, Paty PB, Picon Ai, et al. Stage I rectal cancer: identification of high-risk patients. J Am Coll Surg 1998;186:574–580.CrossRefPubMedGoogle Scholar
  7. 7.
    Heald RJ. Rectal cancer: the surgical options. Eur J Cancer 1995;31A(7/8):1189–1192.CrossRefPubMedGoogle Scholar
  8. 8.
    Rothenberger DA, Wong WD. Abdominoperineal resection for adenocarcinoma of the low rectum. World J Surg 1992; 16(3):478–485.CrossRefPubMedGoogle Scholar
  9. 9.
    Wong CS, Stern H, Cummings BJ. Local excision and post-operative radiation therapy for rectal carcinoma. Int J Radiat Oncol Biol Phys 1993; 25(4):669–675.PubMedGoogle Scholar
  10. 10.
    Rosen L, Veidenheimer MC, Coller JA, Corman ML. Mortality, morbidity, and patterns of recurrence after abdominoperineal resection for cancer of the rectum. Dis Colon Rectum 1982;25(3):202–208.CrossRefPubMedGoogle Scholar
  11. 11.
    Pollard CW, Nivatvongs S, Rojanasakul A, Ilstrup DM. Carcinoma of the rectum. Profiles of intraoperative and early postoperative complications. Dis Colon Rectum 1994;37(9):866–874.CrossRefPubMedGoogle Scholar
  12. 12.
    Miles WE. A method of performing abdomino-perineal excision for carcinoma of the rectum and of the terminal portion of the pelvic colon (1908). CA Cancer J Clin 1971;21(6):361–364.CrossRefPubMedGoogle Scholar
  13. 13.
    Lock MR. Fifty years of local excision for rectal carcinoma. Ann R Coll Surg Eng 1990;72:170–171.Google Scholar
  14. 14.
    Moore HG, Guillem JG. Local therapy for rectal cancer. Surg Clin N Am 2002;82:967–981.CrossRefPubMedGoogle Scholar
  15. 15.
    Buess G. Review: transanal endoscopic microsurgery (TEM). J R Coll Surg Edin 1993;38:239–245.Google Scholar
  16. 16.
    Cataldo PA. Transanal endoscopic microsurgery. Surg Clin N Am 2006;86:915–925.CrossRefPubMedGoogle Scholar
  17. 17.
    Desmartines N, von Flue MO, Harder FH. Transanal endoscopic microsurgical excision of rectal tumors: indications and results. World J Surg 2001;25:870–875.CrossRefGoogle Scholar
  18. 18.
    Nascimbeni R, Burgart LJ, Nivatvongs S, Larson DR. Risk of lymph node metastasis in T1 carcinoma of the colon and rectum. Dis Colon Rectum 2002;45:200–206.CrossRefPubMedGoogle Scholar
  19. 19.
    Sitzler PJ, Seow-Choen F, Ho YH, Leong APK. Lymph node involvement and tumor depth in rectal cancers: an analysis of 805 patients. Dis Colon Rectum 1997;40:1472–1476.CrossRefPubMedGoogle Scholar
  20. 20.
    Saclarides TJ, Bhattacharyya AK, Britton-Kuzel C, Szeluga D, Economou SG. Predicting lymph node metastases in rectal cancer. Dis Colon Rectum 1994;37:52–57.CrossRefPubMedGoogle Scholar
  21. 21.
    Mellgren A, Sirivongs P, Rothenberger DA, Madoff RD, Garcia-Aguilar J. Is local excision adequate therapy for early rectal cancer? Dis Colon Rectum 2000;43:1064–1074.CrossRefPubMedGoogle Scholar
  22. 22.
    Garcia-Aguilar J, Mellgren A, Sirivongs P, Buie D, Madoff RD, Rothenberger DA. Local excision of rectal cancer without adjuvant therapy. A word of caution. Ann Surg 2000;231(3):345–351.CrossRefPubMedGoogle Scholar
  23. 23.
    Bleday RB, Breen E, Jessup JM, Burgess A, Sentovich Sm, Steele G. Prospective evaluation of local excision for small rectal cancers. Dis Colon Rectum 1997;40:388–392.CrossRefPubMedGoogle Scholar
  24. 24.
    Paty PB, Nash GM, Baron P, et al. Long-term results of local excision for rectal cancer. Ann Surg 2002;236(4):522–530.CrossRefPubMedGoogle Scholar
  25. 25.
    Nascimbeni R, Nivatvongs S, Larson DR, Burgart LJ. Long-term survival after local excision for T1 carcinoma of the rectum. Dis Colon Rectum 2004;47:1773–1779.CrossRefPubMedGoogle Scholar
  26. 26.
    Greenberg J, Lipsitz S, Greenberg C, Bleday R. (unpublished results). Google Scholar
  27. 27.
    Lee W, Lee D, Choi S, Chun H. Transanal endoscopic microsurgery and radical surgery for T1 and T2 rectal cancer. Surg Endosc 2003;17(8):1283–1287.CrossRefPubMedGoogle Scholar
  28. 28.
    Lezoche E, Guerrieri M, Paganini AM, Feliciotti F. Long-term results of patients with pT2 rectal cancer treated with radiotherapy and transanal endoscopic microsurgical excision. World J Surg 2002;26:1170–1174.CrossRefPubMedGoogle Scholar
  29. 29.
    Maslekar S, Pillinger SH, Monson JRT. Transanal endoscopic microsurgery for carcinoma of the rectum. Surg Endosc 2006;21:97–102.CrossRefPubMedGoogle Scholar
  30. 30.
    Borschitz T, Heintz A, Junginger T. Transanal endoscopic microsurgical excision of pT2 rectal cancer: results and possible indications. Dis Colon Rectum 2007;50:292–301.CrossRefPubMedGoogle Scholar
  31. 31.
    Buess G. Transanal endoscopic microsurgery. Surg Oncol Clin N Am 2001;10:709–731.PubMedGoogle Scholar
  32. 32.
    Floyd ND, Saclarides TJ. Transanal endoscopic microsurgical resection of pT1 rectal tumours. Dis Colon Rectum 2005;49:164–168.CrossRefGoogle Scholar
  33. 33.
    Morson BC, Bussey HJ, Samoorian S. Policy of local excision for early cancer of the colorectum. Gut. 1977;18:1045–1050.Google Scholar

Copyright information

© Springer Science+Business Media, LLC 2009

Authors and Affiliations

  • Joel E. Goldberg
    • 1
  • Ronald Bleday
  1. 1.Brigham and Women’s Hospital, Harvard Medical SchoolBostonUSA

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