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Файл:Ординатура / Хирургия / Библиотека им академика М.И. Перельмана / Книга_1519_Библиотеки_им_академика_М_И_Перельмана.pdf
Diffi cult Decisions in Surgery:
An Evidence-Based Approach
NeilHyman
KonstantinUmanskiy Editors
Di cult
Decisions in
Colorectal
Surgery
www.ebook3000.com
Difficult Decisions in Surgery:
An Evidence-Based Approach
Series Editor
Mark K. Ferguson
For further volumes:
http://www.springer.com/series/13361
Neil Hyman • Konstantin Umanskiy
Editors
Difficult Decisions in
Colorectal Surgery
www.ebook3000.com
ISSN 2198-7750 ISSN 2198-7769 (electronic)
Difficult Decisions in Surgery: An Evidence-Based Approach
ISBN 978-3-319-40222-2 ISBN 978-3-319-40223-9 (eBook)
DOI 10.1007/978-3-319-40223-9
Library of Congress Control Number: 2016959469
© Springer International Publishing Switzerland 2017
This work is subject to copyright. All rights are reserved by the Publisher, whether the whole or part of
the material is concerned, specifically the rights of translation, reprinting, reuse of illustrations, recitation,
broadcasting, reproduction on microfilms or in any other physical way, and transmission or information
storage and retrieval, electronic adaptation, computer software, or by similar or dissimilar methodology
now known or hereafter developed.
The use of general descriptive names, registered names, trademarks, service marks, etc. in this publication
does not imply, even in the absence of a specific statement, that such names are exempt from the relevant
protective laws and regulations and therefore free for general use.
The publisher, the authors and the editors are safe to assume that the advice and information in this book
are believed to be true and accurate at the date of publication. Neither the publisher nor the authors or the
editors give a warranty, express or implied, with respect to the material contained herein or for any errors
or omissions that may have been made.
Printed on acid-free paper
This Springer imprint is published by Springer Nature
The registered company is Springer International Publishing AG
The registered company address is: Gewerbestrasse 11, 6330 Cham, Switzerland
Editors
Neil Hyman
Medical Center
University of Chicago
Chicago, IL
USA
Konstantin Umanskiy
Medical Center
University of Chicago
Chicago, IL
USA
I dedicate this book to my sons EJ and Seth,
who have been a never-ending source of
pride and joy from the moment they were
born, and always the reason for everything.
Neil Hyman
I dedicate this book to my parents Yakov and
Eugenia.
Konstantin Umanskiy
www.ebook3000.com
vii
Preface
Colon and rectal surgery may very well be on the cusp of a golden age. Our spe-
cialty is thriving and our ACGME-approved training programs are extremely popu-
lar among the best and brightest general surgery residents. Breathtaking advances in
minimally invasive surgery have occurred over the past quarter century including
laparoscopic bowel resection, robotic surgery, endoscopic techniques such as endo-
scopic mucosal/submucosal resection, and transanal approaches such as transanal
endoscopic microsurgery and transanal minimally invasive surgery. Innovation in
these areas has made surgery safer for many of our patients, enabled sphincter pres-
ervation, and reduced the period of disability that many experience after treatment.
However, in addition to the obvious benefits of these disruptive technologies, many
long-standing questions persist and new ones have been raised.
1. What is the most appropriate use of this new and often more expensive technol-
ogy? Does the evidence really support the notion that everything new is really
better?
2. Considering the primacy of patient safety, how do we decide who should be
credentialed to do what?
3. Should any surgeon be able to use any technique they wish, irrespective of cost,
efficacy, and demonstrated competence?
4. Should these new technologies be evaluated first by a select group of high vol-
ume/experienced surgeons in a controlled and measured environment before
more widespread adoption?
5. Do we really have adequate hypotheses and frameworks of understanding for the
common diseases we treat?
6. Without them, can we really devise rational treatment approaches for these
maladies?
7. As such, are almost all our treatments largely empiric and lacking in the basic
scientific underpinnings that would move us beyond therapeutic “hail Mary’s”?
With this state of affairs, the practice of colon and rectal surgery has largely been
driven by expert opinion and the practice of thought leaders – it is often the best we
have. In this book, we have put together a select and highly respected group of
viii
leaders in our field and asked them both to critically review the evidence in a con-
troversial area which they have typically contributed to and investigated during their
career. We also asked them to supplement this with their clinical insights and per-
sonal experience. This is not a comprehensive textbook of colon and rectal surgery
which attempts to review the basic anatomy and physiology of the vast spectrum of
problems one may encounter in the small intestine, colon, rectum, and anus. Many
excellent textbooks like this already exist. Rather, we have selected a broad array of
difficult and often controversial problems that the surgeon who deals with colorectal
disease often encounters. We asked our experts to imagine that they received a
phone call from a busy surgeon in the surgeon’s lounge who wanted to know how a
particular challenging patient management issue should be handled. The goal was
not to list every treatment that has ever been described or utilized.
1. What are my best options?
2. What is the best evidence for/against these options in the literature?
3. How do I decide?
4. What do you think and what do you do?
The reader will be able to see what the highest quality evidence available exists
to guide our management decisions. However, it will be evident that there is always
going to be considerable room for alternative opinions and approaches. A different
acknowledged expert with considerable clinical experience and knowledge of the
applicable evidence may see things differently and approach the same problem
using a very different algorithm. Indeed, as much as we like to talk about evidence-
based approaches, the “evidence” for much of what we do is often lacking and
meager. We hope that the reader will find real help and a sense of perspective from
this book. We particularly hope that we inspire our trainees and junior colleagues to
uncover new paradigms of care, contribute high quality evidence to the literature,
and advance the scientific underpinnings of our management decisions. Our patients
deserve no less!
Chicago, IL, USA Neil Hyman
Preface
www.ebook3000.com
ix
We gratefully acknowledge the talents, expertise, and assistance of Ms. Abby
Larson – without her, there would be no book. We also thank Dr. Mark Ferguson for
his guidance and leadership and Kumar Athiappan of Springer for his diligence and
responsiveness. We also thank our mentors, colleagues, fellows, residents, students,
and patients who provide us the inspiration to learn and improve every day.
Acknowledgments
xi
Contents
1 Introduction . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1
Konstantin Umanskiy
2 Evaluating Evidence . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 7
W. Donald Buie
Part I IBD
3 IBD: Management of Symptomatic Anal Fistulas
in Patients with Crohn’s Disease . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 19
Lisa S. Poritz
4 IBD: Management of a Painful Anal Fissure
and Skin Tags in Patients with Crohn’s Disease . . . . . . . . . . . . . . . . . . 29
Nicole M. Saur and Joshua I.S. Bleier
5 IBD: Elective Surgical Management in Patients
with Ulcerative Colitis-How Many Stages? . . . . . . . . . . . . . . . . . . . . . . 35
Roger D. Hurst
6 Which Ulcerative Colitis Patients Should Not
Have Ileal Pouch-Anal Anastomosis . . . . . . . . . . . . . . . . . . . . . . . . . . . . 45
Scott A. Strong
7 Management of Pouch-Vaginal Fistulas . . . . . . . . . . . . . . . . . . . . . . . . . 53
Ido Mizrahi and Steven D. Wexner
8 Crohn’s Colitis and Ileal Pouch Anal Anastomosis . . . . . . . . . . . . . . . . 65
C. Peirce and Feza H. Remzi
9 Steroid Management in Patients Undergoing
Surgery for IBD . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 73
Karen Zaghiyan and Phillip Fleshner
www.ebook3000.com
xii
10 IBD: Management of Dysplasia in Patients with
Ulcerative Colitis . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 83
Tara M. Connelly and Walter A. Koltun
11 Post-operative Prophylaxis in Patients with Crohn’s Disease . . . . . . . 97
Jonathan Erlich and David T. Rubin
Part II Colon Cancer
12 Follow-Up in Patient’s After Curative Resection
for Colon Cancer Surveillance for Colon Cancer . . . . . . . . . . . . . . . . 115
Clifford L. Simmang
13 Management of Patients with Acute Large Bowel
Obstruction from Colon Cancer . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 121
Marc A. Singer and Bruce A. Orkin
14 Utility of Primary Tumor Resection in Asymptomatic,
Unresectable Metastatic Colon and Rectal Cancer . . . . . . . . . . . . . . . 139
Michael Pezold, Geoffrey K. Ku, and Larissa K. Temple
15 Management of Large Sessile Cecal Polyps . . . . . . . . . . . . . . . . . . . . . 153
Brett Howe and Richard L. Whelan
16 Stage II Colon Cancer: Towards an Individualized Approach . . . . . . 163
Blase N. Polite
Part III Rectal Cancer
17 Rectal Cancer: Management of T1 Rectal Cancer . . . . . . . . . . . . . . . 175
Woon Kyung Jeong and Jose G. Guillem
18 Management of T
2
Rectal Cancer . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 183
Peter A. Cataldo
19 Clinical Complete Response after Neoadjuvant
Chemoradiotherapy in Rectal Cancer:
Operative or Non-Operative Management? . . . . . . . . . . . . . . . . . . . . . 191
Miranda Kusters and Julio Garcia-Aguilar
20 Management of the Patient with Rectal Cancer Presenting
with Synchronous Liver Metastasis . . . . . . . . . . . . . . . . . . . . . . . . . . . . 205
Shafik M. Sidani and Maher A. Abbas
21 Who Needs a Loop Ileostomy After Low Anterior Resection
for Rectal Cancer? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 233
Walker Julliard and Gregory Kennedy
Contents