Individualized laparoscopic and related technique in rectal cancer surgery

[Extract from Preface] The main studies listed in each chapter were carefully selected as to reflect the critical knowledge essential in each of the important steps to overcome the main challenges toward the success in achieving the best possible outcomes in rectal cancer patient care. However, the main original contribution of the thesis was demonstrated clearly in "Chapter 3: Laparoscopic surgery for rectal cancer" where the proposed laparoscopic pull-through with coloanal anastomosis was highlighted. The chapter showed a prospective comparative study comparing all aspects of the two techniques; laparoscopic ultralow anterior resection versus laparoscopic pull-through with coloanal anastomosis for rectal cancers. All the published studies involved in each chapter of the thesis were carefully illustrated in their original format with my great respect to the international peer-review. Nevertheless, each chapter contained the overview aiming to state the connectivity of the ideas for each specific detail contained in each chapter. Despite the fact that the majority of the studies were conducted in high-volume, specialized centers, it was a real challenge to organize prospective studies for highly specific research questions over the limited time of my doctorate degree study. Chapter Overview. Chapter 1: Introduction. This chapter described the context of this research; why rectal cancer treatment is challenging; impact of multidisciplinary treatment on the outcomes. Chapter 2: Overview in colorectal cancer treatment. To review of role of various treatment modalities and variations to optimise both short-term and long-term outcomes; Hiranyakas A, Yik Hong H. Surgical Treatment of Colorectal Cancer – a Review. Int Surg. 2011; 96(2):120-6. Chapter 3: Laparoscopic surgery for rectal cancer. To discuss and propose appropriate laparoscopic techniques / approaches in the challenging surgical conditions to achieve the best possible outcomes; Hiranyakas A, Yik Hong H. Laparoscopic Ultralow Anterior Resection Versus Laparoscopic Pull-through with Coloanal Anastomosis for Rectal Cancers – a Comparative Study. Am J Surg. 2011; 202(3):291-7. Chapter 4: Factors influencing rectal cancer treatment outcomes. To discuss and propose the factors influencing the optimal outcomes for rectal cancer treatment; Hiranyakas A, Yik-Hong H, da Silva, GM, Wexner SD, Allende D, Berho M. Factors Influencing Circumferential Resection Margin in Rectal Cancer. Colorectal Dis. 2013 ;15(3):298-303. Chapter 5: Technique to avoid postsurgical complication. To discuss and propose surgical techniques essential in avoiding serious postsurgical consequences; Hiranyakas A, da Silva GM, Denoya P, Shawki S, Wexner SD. Colorectal Anastomotic Stricture: Is it associated with inadequate Colonic Mobilization? Tech Coloproctol. 2013 ;17(4):371-5. Chapter 6: Protocols for rapid recovery. To discuss in depth for the appropriate immediate postsurgical-care protocols to achieve the smooth and rapid recovery (among the most common diseased population); Hiranyakas A, Bashankaev B, Seo CJ, Khaikin M, Wexner SD. Epidemiology, Pathophysiology and Medical Management of Postoperative Ileus in the Elderly. Drugs Aging. 2011; 28(2):107- 18. Chapter 7: Closure of the ileostomy. To discuss and propose the necessity of certain surgical procedures to enhance optimal immediate postsurgical outcomes in low rectal cancer patients; Hiranyakas A, Rather A, da Sliva GM, Wexner SD, Weiss EG. Loop ileostomy Closure after Laparoscopic vs. Open Surgery: Is There a Difference? Surg Endosc. 2013 ;27(1):90-4. Chapter 8: Treatment of common stomal complication. To discuss and propose minimally invasive surgical approaches in the treatment of the common stomal consequence; Hiranyakas A, Yik Hong H. Laparoscopic Parastoma Hernia Repair, Multi-media Article. Dis Colon Rectum 2010; 53(9):1334-6. Chapter 9: Conclusion, outcomes and future research directions. This chapter gives the conclusions from the studies and proposes future research directions.