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The first 25 slides, exactly as they appear. The full deck has 83 content slides.
General Surgery
Perspective on Rectal Cancer (B)
Built from Maingot's Abdominal Operations
What’s inside
10 sections · 83 slides
Overview
- Scope of this commentary
- Points of agreement and points of challenge
Anatomic landmarks
Where you measure a rectal tumour from decides how it is treated
- Purpose of measuring tumour level
- The three landmarks in use
- Anal canal, sphincters and the dentate line
- The dentate line as a tissue boundary
- Effect of body habitus on measured tumour level
- The 5 cm lesion in two body types
- Variability of the anorectal ring
- Digital rectal examination of a low rectal tumour
- Consequences of inconsistent landmarks
- Anal canal anatomy and the muscles of continence
Preoperative assessment
Baseline imaging, and where a PET scan earns its cost
- Baseline imaging before rectal cancer surgery
- Selective use of PET scanning
- Whole-body PET and CT display
- Selective PET versus a repeat CT at three months
TNM staging
How the seventh edition regrouped stages II and III
- The three questions behind a stage
- The seventh edition and the Hindgut Taskforce
- Stage groupings from 0 to IV
- Reading the stage groupings
- Traditional subdivisions of stages II and III
- Data behind the seventh-edition changes
- Reclassification of T4b N0 tumours
- Tumours upgraded to stage IIIB
- Tumours reclassified as stage IIIC
- Clinical value of the reclassifications
Perioperative management
Where habit still outruns evidence
- Evidence and practice in perioperative care
- Oral mechanical bowel preparation
- Positions on routine bowel preparation
- 99%
- Interpreting the 2003 survey
- Proposed mechanism of harm from bowel preparation
- Reported complications of bowel preparation
- Remaining indications for bowel preparation
- Alternative practices at other centres
- The 2009 SSAT debate
- Determinants of wound infection
- Surgical Care Improvement Project measures
- Antibiotic timing and duration
- Single-dose ertapenem in teaching hospitals
- Urinary catheter removal in colorectal surgery
Local excision
Removing the tumour alone, and who can safely be offered it
- What local excision means
- Evidence base for transanal excision
- Selection criteria for T1 tumours
- Differentiation of colorectal adenocarcinoma
- The unresolved question of T2 tumours
- Benefits and the challenge to them
- Limits of current selection criteria
- Questions that markers alone will not settle
- Influence of surgical technique and volume
- The transcoccygeal approach
- Alternatives to the transcoccygeal approach
Quality of life
The endpoint that shapes four separate treatment decisions
- Quality of life as an endpoint
- Decisions shaped by quality of life
- Lateral pelvic lymph node dissection
- Indications for pelvic radiation
- Low anterior resection syndrome
- Colonic J-pouch: benefits and limits
- Choosing the bowel segment for a pouch
- Palliation with established distant disease
- Sequencing treatment for an asymptomatic primary
- Variations on the resection plan
- Local invasion and pain control
- Surgery for locally advanced and recurrent disease
- Stenting versus faecal diversion
- Permanent colostomy after resection for rectal cancer
Operative technique
Total mesorectal excision and one surgeon's standing routine
- Total mesorectal excision
- Pathologic assessment of the specimen
- Preoperative routine in the author's practice
- Thromboprophylaxis, haemostasis and drains
Postoperative care
Feeding patients earlier than tradition allowed
- Early refeeding after bowel surgery
- Evidence for early enteral feeding
- 80-90%
- A patient-controlled postoperative diet
- Foods encouraged and avoided
Summary
What to carry away from this commentary
- Key points on landmarks and staging
- Key points on perioperative practice
- Key points on excision, quality of life and recovery
- References
- References (continued)
- References (continued)
- References (continued)
- Maingot's Abdominal Operations, 12th Edition