What Is the History of Rectal Cancer Treatment?
Rectal cancer treatment has improved dramatically since the end of the nineteenth century. Although we owe a great deal to advances in technology and patient care, the driving force behind this has predominantly been the understanding of the natural histo
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What Is the History of Rectal Cancer Treatment? M.M. Lange and H.J.T. Rutten
Rectal cancer treatment has improved dramatically since the end of the nineteenth century. Although we owe a great deal to advances in technology and patient care, the driving force behind this has predominantly been the understanding of the natural history of the disease. Improved surgical techniques based on recognition of anatomical and pathologic principles as well as multimodal treatment strategies have reduced mortality from 100% to less than 4% for locally advanced rectal cancer. In order to understand the basis of modern rectal cancer treatment, it is necessary to recognize the achievements of the early pioneers in the past.
5.1
ow Did Rectal Cancer Turn H into Curable Disease?
Although rectal cancer was recognized by John of Arderne in the thirteenth century, rectal resection was not performed until the early nineteenth century [1]. Till then, defunctioning colostomy,
M.M. Lange, MD PhD (*) Leiden University Medical Center (The Netherlands), Department of Surgery, Leiden, The Netherlands e-mail: [email protected] H.J.T. Rutten Department of Surgery, Catharina Ziekenhuis Eindhoven, 5602 ZA, Eindhoven, The Netherlands
as described by Amussat, was the only procedure used for the palliation of obstructive rectal cancer [2].
5.1.1 Perineal and Sacral Resection The first direct removal of rectal cancer was probably performed accidentally by Jean Faget in 1739, by using a perineal approach for a bilateral ischiorectal abscess, which turned out to be caused by perforated rectal cancer [3]. Jacques Lisfranc achieved the first rectal resection for uncomplicated rectal cancer through a perineal approach in 1826 [4]. This technique can be best described as an endorectal approach and therefore was limited to very distal tumours. Most of rectal cancers did present themselves as advanced tumours, and Dieffenbach introduced a wider access by cutting the posterior part of the anus and sphincter in the direction of the coccyx. Now larger tumours could be removed. Still, radical resections were rare and this procedure could only be described as a palliative approach for obstructing tumours. Billroth wrote in his legendary textbook with Pita that he only cured 3 out of 33 of his patients. Many died postoperatively and the survivors developed local recurrences within months. From his point of view rectal cancer was an incurable disease, which should not be operated upon in general [5]. However, progress in surgical technique continued. The next step
© Springer-Verlag Berlin Heidelberg 2018 V. Valentini et al. (eds.), Multidisciplinary Management of Rectal Cancer, https://doi.org/10.1007/978-3-319-43217-5_5
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forward in the perineal approach was done by Kocher in 1874, who gained wider access by the removal of the coccyx. By doing so he could also preserve the distal anorectal sphincter in some cases, which enabled him to restore continuity, first with direct anastomoses, and later pull- through techniques were developed. For b
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