Subject Index

abdominal aortic nerve plexus 126 abdominoperineal resection (APR) 20, 29,

165, 184-185,225,413-416 abdominoperineal resection - urinary and

sexual disturbances 248 aberrant crypt foci 103-104 accessory pudendal artery 127-128 ACPS, Australian Clinicopathological Staging

system 31,51,65 adenoma 103-104, 146,288 adhesions, in laparoscopy 275 adjuvant chemo-radiotherapy 37, 40, 376,

387-389 adjuvant chemotherapy 30, 37, 225, 240 adjuvant cytotoxic portal vein infusion 430 adjuvant radiation therapy 20, 30, 37,

373-380, 384-390 adjuvant therapy, morbidity 235, 374, 376,

378-380 adjuvant therapy, mortality 235, 377, 397 ADT, Working group of German Cancer

Centers 59 AJC, American Joint Committee for Cancer

Staging and End Results Reporting 49 AJCC's Manual for Staging of Cancer 52 AlCC, American loint Committee on

Cancer 49 Alcock's (pudendal) canal 248 alcohol intake 5 al1ele 102, 108 American Joint Committee for Cancer Staging

and End Results Reporting (AlC) 49 American Joint Committee on Cancer

(AJCC) 49 American Society of Anaesthesiologists

(ASA) 409, 435 American Society of Colon and Rectal

Surgeons, registry guidelines 285 amplification 102 anal canal 84, 134, 248, 312 anal continence 193 anal hiatus 223, 299 anal pressure 320 anal transitional zone 339 anal verge 412

anastomosis integrity testing by air insufflation 273

anastomotic dehiscence 307 anastomotic fibrosis 299 anastomotic fistula 316 anastomotic healing 299 anastomotic height 328 anastomotic leakage 14, 192,204,216,230,

276, 278, 299-300, 320-322, 326-332, 367 clinical 300 conservative treatment 330 long term functional consequences 320 radiological 300, 327 risk factors 328-330 secondary 322

anastomotic stenosis 300 anastomotic stricture 299 aneuploidy 104 ano-coccygeal raphe 209 anorectal function 299,307,316-319,337 anorectal function assessment form 344-346,

348-351 anorectal junction 209,312-313 anorectal nodes of Gerota 169 anorectal ring 30 I ANP, autonomic nerve preservation

165-167,177-179,222-223 anterior resection 20, 29, 35, 207 anterior resection syndrome 320 antigen-presenting cel1 103 aorta 126 aortic autonomic nerve plexuses 245 aortic bifurcation 127 aortic plexus 245 aortic sympathetic plexus 189 APC gene 101, 104 APE, abdominoperineal excision 203-204,

206,210 apical lymph node 64, 148,416 apoptosis 104, 109 APR, abdominoperineal resection 20, 29,

35-36,165,184-185 AR, anterior resection 29, 35, 165, 207 areolar planes 206, 413 areolar tissue 207-209,247,271,413

448

ASA, American Society of Anesthesiologists 409, 435

ascending left colic artery 207 ASPCR, allele-specific PCR 106 Astler-Coller staging system 51 asymptomatic family members 408 asymptomatic leak 322 asymptomatic recurrence 17 audiovisual teaching programme for

TME 216 auditing of surgery 79, 353, 363, 370, 431 Australian Clinicopathological Staging system

(ACPS) 31,51 . autonomic nerve preservation (ANP)

165-167,177-179,222-223 autopsy 3, 6, 196, 428

Babcock graspers 269 barium enema, double contrast 410 basis for diagnosis 6 Bcl-2 gene 103, 104, 107 benchmark studies 193 bi-Iobed lipoma 209 biofragmentable ring 418 biological aggressiveness 64 bivalve retractor 306 bladder 123,245-247 bladder function, dysfunction 117, 122,

259-261 bladder neck 223 blind end of J-limb 322 blood flow 329,419 blood supply to rectum 355 blood transfusion 216 blood vessel invasion (BVI) 224, 238 blunt dissection 184,223,230,234,256,413 blunt extraction 40 bone marrow 58 Bouin's fixative 78 bowel obstruction 408 broadcast-quality television 217 BVI, blood vessel infiltration 224, 238

c-myc over-expression 107 caloric intake 5 cancerocidal washout (pelvis, intraluminal)

414,418 carbon dioxide pneumoperitoneum 268 case mix 32, 36 category I-IV lymph node dissections

(Japan) 248-249, 256 catenins 104 cavernous nerve 125 CBC, complete blood cell count 221 CD 44 cell adhesion molecule 103 CEA, carcino-embryonic antigen 17, 211,

411, 431

celiac plexuses 245 cell nucleus 104 cell surface receptors 104

Subject Index

central tendon (perineal body) 248 cervical vaginal junction 223 cetrimide 38 chemoradiation, see adjuvant chemo-

radiotherapy chemotherapeutic agents 109 chemotherapy 30 chest infections 366 chest physiotherapy 274 chest X-ray 221, 410 chromosome I p 104 chromosome 8p 104 chromosome II q 104 chromosome 14q 104 circular stapling devices 204, 210 circulating tumour cells 186 circumferential dissection 413 circumferential margin 37, 192,217,277 circumferential resection margin (CRM) 66,

70-79, 420-421 clear margins 34 clearing method (fat-) 147 clinical epidemiology 393 clinical staging system (CS) 50, 83, 90 clinicopathologic staging 50-51 clinicopathological staging system 50, 63 clinimetrics 409 clitoris, dorsal nerve of 248 close shave (of distal margin) 146 closed-circuit television 217 cluster bowel novements 338 coccygeal (m.) 136 coccyx 135, 248, 306 codon 104 colectomy, subtotal 20 coloanal anastomosis 223,297-311,312-316 colonic J-pouch, complications 323 colonic polyps 410 colonic pouch 313,418-419 colonic reservoir 315-316 colonoscopy 221, 266, 410 colorectal anastomosis, technique 303-304 colostomy, palliative 211 common iliac artery/vein 126 complete blood cell count (CBC) 221 compression stockings 267 computed tomography (CT) 84, 221 Concord Hospital Clinicopathologic Staging

System 51 cone down 39 cone-wise dissection 184 confounding factors 393 coning 75 coning effect 185

Subject Index

coning prevention 415 consultant surgeon 23, 26 continence 209 continence, gas, flatus 337-338 contrast radiology 266 conventional operation (Japan) 189 conventional operation (non-TME rectal

resection) 25-26,230,234,413,415-416 conventional rectal resection - definition 256 covering colostomy 419 Cox proportional hazard regression 20, 395 CRM, circumferential resection margin 66,

70-79, 420-421 Crohn's like lymphoid reaction 150 CS, clinical staging system 50, 83, 90 CT, computed tomography 84,91,211,221 curative excision (RO) 64 curative operation 31 curative operation, definition 34, 196 curative treatment 50 cystometrogram 340 cytocidal solution 38 cytology 3

D-classification of rectal cancer operations 240

Danish Cancer Registry 6 DCC, deleted in colorectal cancer gene 103 DCO, death certificate only 6-7 deaths from competing causes 395 defecation frequency 318 de functioning colostomy, temporary 216,

224,314,331 defunctioning loop ileostomy 273,314,331 deleted in colorectal cancer gene (DCC) 103 deletion 102 denervation 160 Denoix, Pierre 49 Denonvillier's fascia 120,129-132,173,

208-209, 223, 246, 252 dentate line 412 descending colon 302 desmoplastic reaction, fibrosis 146 detachable anvil (circular stapler) 304 differentiation, degree of 224 discontinous growth 148 discontinous spread 39 dissection, lateral pelvic nodes 30 dissection, manual 19,415 dissection, sharp 38 disseminated disease 39 distal clearance 29 distal intramural spread 187 distal lymphatic spread 413 distal margin 25, 313, 354 distant failure 39 distant metastases 11, 53-54

distant recurrence, definition 428 distant spread 11, 71 diverting stoma 326-332 diverting stoma, closure rate 327 DKG, German Cancer Society 59 DNA

aneuploidy 104 mismatch repair 102 mismatch repair gene 108 ploidy 390 repair enzymes 106 repair genes 101-102 replication 102 sequencer 107 sequencing 106

documentation system 59 Doppler ultrasound 329 dorsal nerve of penis (clitoris) 248 double stapling 305, 315, 418 doughnuts 79 doughnuts, completeness of 273, 332 downstaging 298, 395 downward lymph node spread 415 ductus deferens 125 Dukes'staging 31,51 Dukes' staging system, modified,

Astler-Coller 31,51,64 Dukes' staging system, modified,

Kirklin 51, 64 Dukes' staging system, modified,

Turnbull 51,64 Dukes, Cuthbert 49 dye injection technique 155 dyspareunia 342 dysplasia 110, 146

E cadherin 104 earlier diagnosis 15 early carcinoma 53 ejaculation, loss of 176, 178, 246, 250 ejaculation, retrograde 207, 341 elastin stain 150 embryology 406 emergency presentation 408 emergent colostomy 330 en bloc resection 406 end point

disease-free survival 394 local recurrence 14, 394 quality of life 14, 396 sexual functioning 14 survival 14, 394

end-to-end anastomosis 321

449

end-to-end anastomotic device (EEA) 299 end-to-end circular stapler 418 endoloop 286 endopelvic fascia 245-247

450

endorectal surface coil MRI 87 endorectal ultrasound (EUS) 51, 101,411 endorectal USS 278 endoscopic linear stapling device 267, 286 endoscopic stapler 273 EORTC, European Organization for Research

and Treatment of Cancer 377, 385 EPL, extended pelvic lymphadenectomy 30,

37, 256-262 erectile impotence 341 erection 248, 341 erection, loss of 176, 178, 208 erigent nerves 120, 223, 246 Erlangen Prognostic Groups 51 ES, endosonography 87-88 EUROCARE 16 exfoliated malignant cells 38, 107, 210, 418 exophytic growth 60 expanding carcinoma 146 extended dissection 176-179 extended lymphadenectomy 161-164 extended pelvic lymphadenectomy (EPL) 30,

37, 189, 256 external iliac artery 127 external urethral sphincter 248 extracapsular nodal penetration 224 extramural venous invasion 149

5 cm rule 187, 204 5-fluorouracil 109 factor VIII immunohistochemical

examination 150 familial adenomatous polyposis (FAP) 101,

104, 110 fascia propria of rectum 117 fascial planes 38 fat intake 5 fecal continence 299, 307, 337-338 fecal evacuation 307, 337-338 fecal fistula 328 fecal incontinence 316, 320 fecal peritonitis 409 fibrosis 79 first-degree relative 110 flush ligation of IMA 30, 189 follow-up 14, 34, 211, 431 follow-up colonoscopy 221 fractionation of radiotherapy 374 fragmentation of stool 316 free tumour cells 71 frequency of defecation 316-317,320,

337-338

gas less laparoscopy 289 Gastrointestinal Study Group (GITS) 51 gene inactivation 102 genes 102

Subject Index

germline tissue 105 GITS, Gastrointestinal Study Group 51 Goligher, John 204 gross tumour morphology 60 GTBP gene 101 Gunderson and So sin 51

HAR, high anterior resection 414, 437 Hartmann's resection 20, 34, 211, 275 Hartmann, Henri 204 hematogenous metastases 179 hemostasis 223 heparin 267 hepa tic metastases 150 high anterior resection (HAR) 414, 437 high grade histology 260 high ligation of inferior mesenteric vein

(IMA) 166, 186,222,257 high-definition television 217 high-grade dysplasia 110 high-risk patients 20 Hill Skills Centre 216 hind gut 206 histological grade 109 histological verification 13 histopathological staging 10 I histopathological workshop 217 hMLH1 gene 101 hMSH2 gene 101 HNPCC, Hereditary Non-Polyposis

Colorectal Cancer 101, 102, 110, 408 holy plane 77,271 hospital treatment volume 21-22 host reaction 150 hPMS1 gene 101 hPMS2 gene 101 hyperechoic 88 hypoechoic 88 hypogastric nerves 119, 124, 176, 208,

245-252 hypogastric plexus 119

IARC, International Agency for Research on Cancer 6

ICAT, International Comprehensive Anatomical Terminology 420, 422-425, 438-440

identification number, personal 3 ileus (postoperative) 274, 276 IMA, inferior mesenteric artery 30, 118, 126,

189, 207, 250, 286 immunohistochemical staining 109 immunohistology 58 implantation of malignant cells 39, 210, 289,

301,418 impotence 341 inadvertent tumour perforation 40

Subject Index

incidence of rectal cancer 6 prediction 8 time periods 6

incomplete evacuation 299 incomplete removal of tumour 39 inconsistent sacral artery 121 incontinence score 320, 323 incurable tumour 425-426 india ink 78 inferior hypogastric plexus (pelvic

plexus) 120, 123,208, 246, 413 inferior mesenteric artery (IMA) 30, 118,

126, 189, 207, 250, 286 inferior mesenteric plexus 245 inferior mesenteric vein 251 inferior rectal nerve plexus 127 inferior vena cava 129 infiltrating carcinoma 146 inflammation 85 interiliac trigon 245 internal anal sphincter 134 internal iliac artery 127, 134, 189 internal iliac veins 136, 189 internal iliac vessels 38, 246--247, 251-254 internal obturator muscle 117, 246 internal pudendal artery 155 internal pudendal venous plexuses 252 internal sphincter of the anus 209 International Agency for Research on Cancer

(IARC) 6 International Documentation System

(IDS) 407 International Union Against Cancer

(VICC) 49 International Working party on

Clinicopathological Staging for Colorectal Cancer 59

International Working Party Report to the World Congress of Gastroenterology, Sydney 1990 407

intersphincteric rectal excision 94, 97 intraabdominal abscesses 366 intracorporeal anastomosis 269 intramucosal carcinoma 146 intramural spread 187 intraoperative colonoscopy 287 intra rectal ultrasound (USS) 266 invasion 103, 145 invasive margin 60, 146 irrigation of rectal stump 313 ischiorectal fossa 204 isolated tumour cells 58

I-shaped reservoir 313 Japanese Research Society staging system 31,

157

451

K-ras (Kirsten ras) gene mutation 103, 105, 106

Kaplan-Meier method (survival analyses) 225, 395

Karnofsky performance status 409 Kirwan scale for fecal incontinence 338 Kraske 165 Krukenberg tumour 414

lamina propria 147 laparoscopic

abdominoperineal excision 275 anterior resection 275 colotomy 282 intestinal staplers 281 linear cutters 273 mesorectal excision 264 polypectomy 282 port sites 268-269

laparoscopic assisted abdominoperineal resection 264 anterior resection 264 rectal resections 269, 278 resections 269

laparoscopic resection anastomotic leakage 276, 278 excision margins 264 high ligation of inferior mesenteric

vessels 287 learning curve 286--287 operating time 286 port-site recurrence 289-290 postoperative morbidity 278, 282-283 postoperative mortality 283 postoperative small-bowel herniation 286 postoperative small-bowel obstruction

276--277,286 specimen delivery 269 specimen removal 282

laparoscopic surgery 216 wound recurrence 264

laparoscopic ultrasonography 268 laparoscopy

aerosol 289 circular stapled anastomosis 287 conversion to open operation 275 cosmesis 283 elevated intraabdominal pressure 289 gasless 289 high ligation of inferior mesenteric

vessels 270 hospital stay 278, 282-283 incorrect segment removal 287 intracorporeal anastomosis 273 intracorporeal transection of rectum 273 surgeon's lack of sensation 287

452

LAR, low anterior resection 184-185,225 laser-Doppler flowmetry 322,419 lateral dissection (see also lateral pelvic node

dissection and extended pelvic lymphadenectomy) 252-253

lateral ligament 120,121,122,140,175,209, 223,252,271,413

lateral lymph node involvement 36, 169-172, 235-236, 257

lateral margin 193 lateral pelvic lymph nodes 38, 156 lateral pelvic node dissection 30, 161, 163,

166, 172-173 lateral vesical space 246 Lawrie, Rex 206 leakage, see anastomotic leakage Leukovorin (5-formyltetrahydrofolate) 386 levamisole 386 levator ani muscle 117,123,127-128,134,

155,253,312 lifestyle pattern 3

gender difference 4 prognosis 9

limited dissection 176-179 linear logistisk regression 395 linear stapler 210, 273, 314 linear-quadratic (LQ) time formula 374 linkage analysis 106 liver metastases 64, 268 liver ultrasonography 410 Lloyd-Davies position 268 local excision 193 local recurrence (LR) 14,29,31-40,177,179,

185,194-197,307,317,354,357-363, 367-369, 406, 412

actuarial rate 37 after radiotherapy 375 complete surgical excision of 39 definition 19,31,428 inadvertant tumour perforation 36 incidence 22, 33 interinstitutional variability 356-363, 368 intersurgeon variability 357-363,406 risk factors 23, 71 stapled anastomosis 185 survival 24-26, 39

local resection 20, 193 localized tumour 10 log-rank test 395 LOH, loss ofheterozygocity 102,107 longitudinal spread 146 loop ileostomy 273,331 loss of heterozygocity (LOH) 102, 107 low anterior resection (LAR) 184-185,225 LQ, linear quadratic time formula 374 LR, local recurrence 31 lubrication of vagina 341

Subject Index

lumbar splanchnic nerves 126,250 lumbar sympathetic trunks 245 lumbosacral nerve 245 LVI, lymphatic vascular invasion 224,238 lymph node dissection 38, 165 lymph node metastases 64, 77, 79, 93, 148,

153-164 lymph node metastases, occult 85 lymph nodes, non-fat-containing 87 lymph nodes, regional 58 lymphadenectomy, extended 161-164 lymphatic micro-invasion 60 lymphatic vascular invasion (LVI) 234, 238 lymphatic vessels 147 lymphocyte infiltration, peritumoural 60

M classification (TNM/UICC, metastasis) 58 M-status 410 macroscopic involvement of margins (R2) 64 magnetic resonance imaging (MRJ) 86, 92 malignant polyps 109 manometry (anorectal) 317 manual dissection 19,415 margin

circumferential (CRM) 70-79 distal 70, 187,288-289,298,313 invasive 60 lateral 193, 298 proximal bowel 70

marginal artery 329 margins

clear 34 macroscopic involvement (R2) 64 microscopic involvement (Rl) 64 radial 30, 276-277, 279

Masterclass, Royal College of Surgeons 217 matrix for staging system conversion 31 maximal tolerable volume (of neorectum)

318,320 Medline 31 mercuric perchloride 38 mesorectal fascia 117 mesorectallymphatics 413 mesorectal spread 187 mesorectal "tail" 414 mesorectal transection 210, 223 mesorectum 19,30,64, 134, 184,206-207,

220,270-271,312,412 mesorectum, complete resection of 30 mesorectum, distal metastases 75 mesosigmoid 120 metachronous liver metastases 150 metachronous tumour 15 metachronous tumour, asymptomatic 17 metastasis 103 methyl-CCNU (semustine), leukemia 235 micro-invasion 60

Subject Index

micrometastases 39, 58 microsatellite instability 103-104, 107, 110 micro satellites 102, 107 microscopic involvement of margins (RI) 64 microscopic verification 6 micturition 248 micturition, disturbances of 244 mid-rectum 19 middle rectal artery 121,175,209,223,252 middle rectal vein 139 Miles 165, 183,203-206 minimal basis data set 432 mismatch analysis 106 molecular biological techniques 105 molecular grading 106 molecular markers 110 Mormons 4 mortality, prediction 8 mortality, treatment related 40 Moynihan 183, 206 MRC Working Party 229 MRC, Medical Research Council 377 MRI, endorectal surface coil 87 MRI, intrarectal coils 97 MRI, motion artefacts 87 MRI, magnetic resonance imaging 86, 92,

278 mucinous component 238 mucosectomy (rectal) 313 multiplex oligonucleotide ligase detection

test 106 multivariate regression techniques 395 muscularis mucosae 64 muscularis propria 64 mutation 102

named vascular trunks 52, 64 National Colorectal Cancer Project (NCCP)

14 National Finnish Cancer Registry 6 National Institutes of Health (NIH) 53 National Surgical Breast and Bowel Project

(NSABP) 51 NCCTC, North Central Cancer Treatment

group 37 neorectum 312,317,418 neorectum - neorectal capacity 320 nerve injury 223 nerve preservation 160 nerve-sparing procedure 246 nerve-sparing techniques 248-253 nervi erigentes 223, 246 neurogenic bladder 339-340 neurovascular bundle of urinary bladder 178,

208 NIH Consensus Development Conference

(1990) 197

NIH, National Institutes of Health 53 nm23 gene 103, 105, 109

453

no touch isolation technique 30, 185-186, 417 nocturnal erection 342 node-clearing technique 186 Nomina Anatomica 123 non-exophytic 60 non-nodal mesenteric implants 224 non-polyposis hereditary colorectal cancer

(HNPCq 101 North Central Cancer Treatment group

(NCCTq 37 Norwegian Cancer Registry 3, 18 Norwegian Colorectal Cancer Project

(NCCP) 17 NSABP, National Surgical Breast and Bowel

Project 51

obligatory reporting 3, 15, 18 observational methodology 434 obturator fossa 189 obturator nerve 125, 161, 163,246,253 obturator space 159,162,166,173,253 occult lymph node metastases 85 occult metastases 107 oldest age group 13 omentopexy 414 oncogene 104 operative morbidity 167 operative mortality 25 operative records 19, 197 optimal surgery 40, 373, 380, 390, 430 optional descriptors 58 organization of rectal cancer surgery

362-363, 366, 433 outcome measures 426-427

p53 gene 103, 105, 390 p53 molecule 108 palliative laparoscopic resections 286 palliative resection 63 PANP, pelvic autonomic nerve plexus

222-223,413 para-aortic lymphadenectomy 246 para-aortic nodes 127, 161 pararectal space 253 parasympathetic nerves 119, 208 parasympathetic pelvic splanchnic nerves 125 parasympathetic sacral nerve roots 223 paravesical space 253 parietal endopelvic fascia 173 parietal fascia 117, 118, 247 parietal pelvic fascia 134-142, 222 partial meso rectal excision (PM E) 414-415,

437 partial preservation of pelvic nerves 248,

252-253

454

patient controlled analgesia 282 peR, allele specific (ASpeR) 106 peR, polymerase chain reaction 106, 107,

108 pedunculated adenoma 146 pelvic autonomic nerve plexus (PANP)

222-223,413 pelvic dissection planes 239 pelvic fascia 234 pelvic floor 209 pelvic hematoma 322 pelvic lymph node dissection (PLND)

188-191 pelvic lymphadenectomy, wide 260 pelvic lymphadenectomy, extended 30 pelvic nerve plexus 175-177, 253 pelvic nerves 223 pelvic plexus (inferior hypogastric plexus)

123, 245-247 pelvic pouch

continence, gas 316 continence, mucus, stools 316 daytime continence 316 discrimination 316-317 evacuation problems 316--317,324 nighttime continence urgency 316-317,320,323-324

pelvic recurrence (see also local recurrence) 29, 221, 226--228

pelvic sepsis 316 pelvic side wall 173 pelvic splanchnic nerves 125, 223, 246--247 pelvic splanchnic plexus 120 penile tumescence 342 penis 127 penis, dorsal nerve of 248 Penrose drain 314 perforation of bowel 408-409 performance status 409 peri-tumoural lymphocyte infiltration 60 perimuscular invasion 58 perineal muscles 248 perineal nerves 248 perineal skin irritation 339 perineural infiltration (PNI) 150, 224, 238 peritoneal involvement 66, 71, 230 peritoneal reflection 32 peritoneal seeding 153 peritumoural inflammation 88 personal identification number 3 Phannenstiel incision 270 photodocumentation 222 piriformis muscle 117, 136, 208 PLND, pelvic lymph node dissection 188-191 PME, partial mesorectal excision 414-415,

437 pneumoperitoneum 265

Subject Index

PNI, perineural infiltration 150, 224, 238 point mutations 106 polymerase chain reaction (peR) 106 polymorphisms 106 population based studies 39 population-based study 25 port-site recurrences 289-290 posterior vaginal wall 75 postoperative anorectal angle 339 postoperative morbidity 278, 366 postoperative mortality 23, 365 pouch of Douglas 223 pouchitis 324 povidine-iodine 38 pre-sacral fascia 117, 246 pre-sacral fat pad 209 pre-sacral nerves 119, 207-208 pre-sacral veins 118 precancerous conditions 3 preceptorship 239 predisposing factors, ethnic-genetic 3 preoperative clinical staging 82 preoperative radiotherapy 18 presacral pelvic fascia 184 presacral space 223 presacral venous plexus 136, 252 proctoscopy 221 prognosis 9 prognostic factors 60 prognostic groups 60 prognostic index 60 prognostic systems 60 proper rectal fascia 155, 246-247, 252-253 prospective study 26 prostate 123-125, 208 protective pads 338 protective stoma 320-322 proto-oncogenes 102 puborectal muscle 209 pudendal (Alcock's) canal 248 pudendal nerve 127,248 pull-through procedures 306 pursestring suture 304-305 pushing carcinoma 146

quality control of surgery 353 quality of life 14,167 quality of surgical resection 64

R, residual tumour status 50--55 RO resection 356 race 60 radial resection (excision) margins 30,

276--277, 279 radiation therapy 30 radiation therapy, small bowel

obstruction 235

Subject Index

radical prostatectomy 208 radiologic leakage 300 radiotherapy, long term functional results

338-339 radiotherapy, preoperative 230 randomized clinical trials 434 randomized study 27 ras oncogene mutations 104 rate of growth 64 RBI, retinoblastoma gene 104 RCS National Guidelines 67 rectal adventitia 136 rectal cancer

conventional operation (Japan) 189 conventional resection, definition 256 conventional surgery 25, 413, 415 definition 19,31, 194 fixation 83 incidence 6 mortality 10 survival 6,174-175,405 tethering 83

rectal digital examination 83, 301 rectal lymphatics 127 rectal quadrants 83 rectal reservoir 312 rectal reservoir function 320 rectal stricture (after LAR) 230, 299 rectal stump washout 30,224,301-302,313,

414,418 rectal wall, layers 84, 87 rectal washout agents 38 rectosacral fascia, ligament 118, 135-142,

161, 207, 223, 234, 247-248, 413, 415 rectosigmoid 32 rectosigmoid cancer 7 recto vaginal septum 223 rectovesical pouch 252 rectovesical septum 129 rectum, definitions 19, 4 11-412 rectum, subdivision 19, 412 recurrence, asymptomatic 17 recurrence, liver 63 recurrence, local 63 recurrence, peritoneal 63 regional centralization of treatment 353-354 regional spread I I relative survival 6, 10, 394-395 repeat sequences 106 reporting, obligatory 3 resectability 85 residual disease 63 residual tumour (R) status 50-55, 423-425 resting continence 299 resting pressure 320 restriction enzyme cleavage 106 retinoblastoma gene (RBI) 104

455

retractors (anus) 313 retro-rectal space 246 retrograde ejaculation 207, 241 retrograde lymphatic flow 260 retrograde lymphatic spread 158 retroperitoneal lymph node dissection 186 retrorectal space 134,247,251 retrospective study 26 Retzius' fossa 246 rigid proctoscopy 221 risk factors for rectal cancer 4, 5 rotating anvil (circular stapler) 304 Royal College of Surgeons in England 216 RT, radiotherapy 225 Russian STPU staple gun 210

sacral fascia 208 sacral nerve 247 sacral nerve plexus 125, 246 sacral nerve roots 138, 208 sacral promontory 32 sacral splanchnic nerves 124 sacral sympathetic trunk 124-125, 246 sacro-coccygeal raphe 75, 79 sacrum 119, 134, 248, 306 screening 105, 408 seeding (of cancer cells) 224, 301 selection bias 432 self-catherisation 190 seminal vesicles 118-119, 123-125,208,223,

246,252 sensitization of radiation therapy 388 sequential multiple analysis (SMA) 221 sessile adenoma 146, 288 sexual function assessment form 346-348,

351 sexual function, dysfunction 38, 117, 122,

176,244,259-260,341 sexual functioning 14 sexual potency 208 SGCRC, Study Group on Colorectal

Carcinoma 54 sharp dissection 38 SHP, superior hypogastric nerve plexus

126, 129, 246, 250 side-to-end anastomosis 321 sigmoid colon, blood supply 302 signal transduction 104 signet-ring-cell carcinoma 146 Sim's position 221 single-strand conformation polymorfism

(SSSP) 106 site classification 7 skipped metastases 260 sleeve anastomosis SMA, sequential multiple analysis 221 soilage, soiling 307,317-318,338

456

solitary metastasis 221 specialization in rectal cancer surgery 354 specimen

alcohol washing 78 extension of tumour 78 fixed 77 fresh 77 from TME 72,74 gross description 58 handling 58 sampling 58 transverse slicing 70, 72, 78 visual inspection 72

sphincter function 320 sphincter preservation 29 sphincteric involvement 267 spillage (of cancer cells) 301 splanchnic nerves 120 sporadic colorectal cancer 104 squeeze pressure 320 SSSP, single-strand conformation

polymorfism 106 stage migration 425 staging 10, 49, 101

distant spread II localized tumour 10 non-anatomical variables 59 pathological 58 preoperative clinical 82 preoperative irradiation 147 preoperative ultrasonographic 82 regional spread II standardization 58

staging systems accuracy of prediction 65 Astler-Coller 51, 64 Australian clinico-pathological 65 clinical 50, 83 CT 84 Dukes' 51, 64 GITS 51 Gunderson and Sosin 51 Jass 65 Kirklin 51, 64 NSABP 51 TNM 51-60,64 York Mason 51, 83, 90

standard dissection 176-179 standard rectal resection 412-413, 416, 428 standard, definition of 362 standardization, staging 58 standards for specimen evaluation 414,

420 standards of operations 354 stenosis 88 stoma closure, complications 328 stress incontinence, faecal 209 stress incontinence, flatal 209

Subject Index

Study Group on Colorectal Carcinoma (SGCRC) 54

stutter bands 108 submucosa 53, 64 subserosa 64 subtotal colectomy 20 suction drains 274,314 superior hypogastric nerve plexus (SHP) 119,

124, 126, 129,245 superior rectal artery 207, 302, 412 superior rectal nerve plexus 127, 129,246 superior rectal vein 207 surgeon's interest 363 surgeon's lack of sensation in laparoscopy

287 surgeon, classification 75 surgeon, skill 75 surgeon in training 23, 26 surgeon treatment volume 357, 368 surgeon variable, factor 39, 196,218,406 surgical gastroenterologist 23, 26 surgical specimens 3 surveillance methods 17 survival, rectal cancer 6, 65

age groups 6 disease-specific 395 gender 6 improvement 10-11, 394 interinstitutional variability 356-363, 369 intersurgeon variability 357-363 lifestyle pattern 9 time periods 6

survival analysis, life table method 212 Swedish Rectal Cancer Trial 377 sympathetic nerves 161, 208 symphysis pubis 135 symptomatic patients 408 symptoms classification 409 synchronous distant disease 221 synchronous lesions 267, 287 synchronous tumour 15,267,410 systematic review 30 systemic disease 40

telescopic ramifications ofTNM system 56-58 television teaching 216 temporary colostomy 192,331 tenting of nerves 223 tethering of tumour 411 thrombo-embolic prophylaxis 267 thymidylate synthetase 109 time-to-event analyses 20, 395 TME, Total Mesorectal Excision 19,30,

36-37, 191-197,203-219,220-243, 412-431

adjuvant therapy 237-239 distant metastases 229 survival 226

Subject Index

total preservation of autonomic nervous system 248

truncal ANP (autonomic nerve preservation) 237

vs. lateral node dissection 256 TME surgeon 217, 433 TNM (Tumor, Node, Metastasis) staging

system 49, 51-60, 64,425 TNM M (metastasis) classification 58 TNM optional descriptors 58 TNM stage groups 56 TNM staging system 19, 51-60 TNM Supplement 52 TNM telescopic ramifications 56-58 tobacco consumption 5 total colectomy 110 Total Mesorectal Excision (TME) 19, 30,

36-37, 191-197,203-219,320 total preservation of autonomic nervous

system 248 toxicity of radiotherapy 374, 378-380 training curriculum 433 trans-sacral procedures 306 trans-sphincteric procedures 306 transanal drainage 316 transanal endoscopic microsurgery 95-96,

194 trans anal excision 193 transforming growth factor (TGF) 103 translocation 102 transmural colonic blood flow 322 transrectal ultrasound (USS) 266 transsacral excision 193 transsphincteric excision 193 transverse colon 302 Trendelenburg position, reverse 269 Trendelenburg-lithotomy position 222 triple stapling 305 tubular adenoma 146 tubulovillous adenoma 146 tumor proliferation 390 tumour fixity 278, 411 tumour grading 106 tumour islands 147 tumour margin 146 tumour mobility 411 tumour perforation 36 tumour perforation, inadvertent 40 tumour suppressor gene 104, 106 tumour suppressor genes 102

UICC "M" classification 58 UICC stage grouping 56 UICC, Union Internationelle Contre Ie

Cancer 49 UKCCCR colorectal cancer form 66, 68-69 UKCCCR, United Kingdom Coordinating

Committee for Cancer Research 59,410

457

ulcerative colitis 110 United Kingdom Coordinating Committee for

Cancer Research (UKCCCR) 59,410 unresectability 85 upward lymphatic spread 153-154, 169-171 ureter 118,120 ureteral injury 287 urethra, injury during laparoscopic

resection 277 urethra 247 urgency 316-317,320,323 urinary bladder 124-125, 339-340 urinary dysfunction 38 urinary function 339 urogenital diaphragm 248 USS transducers for laparoscopic

ultrasonography 267 USS, intrarectal ultrasound 266 uT-staging 87-88 uterine cervix 123

vaginal examination 209 vaginal fornix 123 vaginallubricartion 341 vaginal wall, posterior 75, 209 vascular invasion 186 vascular micro-invasion 60 vascular staplers 282 venous invasion 150 Veress needle 287 verification, histological 13 Vernier scale 79 videolaparoscopic techniques 281 villous adenoma 146 vincristine 386 visceral endopelvic fascia 173 visceral fascia 117, 134-142 visceral pelvic fascia 134, 220 volume, hospital treatment 21-22 voluntary continence 299

Waldeyer's fascia 118, 136,247-248, 271,273 washout of rectal stump 30, 224 Wessex Cancer Trust 218 wide pelvic lymphadenectomy 260 Wilcoxon test, generalized 20, 225 Will Rogers phenomenon 425 wishbone bifurcation 207 World Congress of Gastroenterology Working

party on Clinicopathological staging (Sydney 1990) 31

wound dehiscence 366 wound recurrence, following laparoscopic

surgery 264, 289 wound recurrence 289

York Mason 51,83 young patients 4

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