| Summary: | Rectal cancer is a major killer. Most of those dying after curative surgery suffer from recurrent disease in the pelvis. Local recurrence is also the only site of failure in up to 50% of patients. A disturbing fact is that the local recurrence rate shows considerably surgeon-related variances. There is now strong evidence that optimizing surgical technique by adopting the principle of total mesorectal excision (TME) will reduce local failure rate, increase the use of sphincter-saving operations, and improve functional results. Surgeons applying this surgical principle will consistently achieve similarly low recurrence rates. This book * reviews the failure patterns after rectal cancer surgery, * discusses the anatomical basis for rectal cancer surgery, * documents the method of spread with emphasis on lymph node metastasis, * describes conventional and optimal surgery, * presents methods of pathological evaluation of the specimen, * documents functional results of and organizational factors influencing rectal cancer treatment. The role of adjuvant therapy, if surgery is optimized, is critically reviewed. In the final chapter, an international documentation system is presented
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