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Surg Clin N Am 86 (2006) xix–xx

Several advances in molecular biology, gastrointestinal endoscopy, diag-
nostic and interventional radiology, minimally invasive surgical techniques,
and chemotherapeutics have improved our ability to manage patients with
benign and malignant colorectal diseases. As with most new discoveries in
medicine, recent changes in the treatment of various colorectal diseases have
confronted varying opinions and controversy and have been slow to be
adopted into routine practice.
In this issue of the Surgical Clinics of North America, we explore several re-
cent advances in the workup and treatment of patients with benign and malig-
nant colorectal diseases. The issue begins with a review of the genetics and
recently identified genetic events and pathways associated with colorectal neo-
plasms. The clinical impact of such information as it relates to genetic counsel-
ing, diagnostic tests, prognosis, and potential novel therapeutics is reviewed.
The past decade has also seen the evolution of several nonsurgical endo-
scopic and radiological techniques aimed at removing the underlying path-
ologic process while minimizing unnecessary tissue manipulation and
trauma. In many instances, this has replaced more-invasive surgical tech-
niques and has resulted in quicker recovery without impacting the quality
of care provided. This issue will examine various advances in both radiolog-
ical imaging and therapeutics, as well as gastrointestinal endoscopic proce-
dures that have, in many instances, replaced traditional surgical procedures.
A similar minimal-access approach has also been adopted by surgeons for
treating various colorectal diseases. The laparoscopic colon era began in the
1990s with the successful and safe adoption of these techniques for the treat-
ment of benign colonic conditions such as diverticular disease and benign
polyps. Large multi-institutional trials performed in North America and Eu-
rope have consistently shown improved short-term outcomes, including re-
duced postoperative pain, reduced analgesia requirement, shorter hospital
stay, and a quicker return of bowel function while preserving long-term on-
cologic outcomes in patients undergoing laparoscopic colon resection for
cancer. We have included a discussion outlining the evidence, controversies,
and technical aspects involved in laparoscopic colon surgery as well as a sep-
arate discussion highlighting the current status of laparoscopic rectal surgery
for both benign and malignant conditions. Separate articles have also been
devoted to discussing evolving technologies such as transanal endoscopic

0039-6109/06/$ - see front matter Ó 2006 Elsevier Inc. All rights reserved.

microsurgery, robotics and telemonitoring, and new techniques used in the

treatment of common perianal diseases and fecal incontinence.
We recognize that one of the challenges associated with the introduction
of new surgical techniques is their safe adoption by practicing surgeons.
Consequently, we have included a separate article outlining effective strate-
gies for transferring knowledge about new techniques and for acquiring the
technical skills necessary for the widespread safe adoption of these tech-
niques by practicing surgeons.
Because traditional multimodality therapy has resulted in overall poor
survival and diminished quality of life in patients with advanced colorectal
cancer, we felt that it was extremely important to highlight several advances
that have occurred in treating these patients. Several newer interventions, in-
cluding radiofrequency ablation, microwave coagulation, hepatic arterial
chemotherapy, and newer systemic chemotherapeutics such as cetuximab,
bevacizumab, and oxalaplatin are reviewed. We have also included a discus-
sion on the use of several new and extremely promising immunomodulatory
agents such as infliximab, anti-IL-12, and IFN alpha and beta currently be-
ing used or tested in the treatment of inflammatory bowel disease.
We are very fortunate to have been able to bring together such an expe-
rienced group of authors, who are truly leaders in there respective fields. We
are grateful to them for generously contributing their time and expertise in
the preparation of this issue. We would also like to thank Catherine Bewick
of Elsevier for her tremendous commitment and tireless support in bringing
this issue to publication. The current collection of articles provides the
reader with the most recent knowledge regarding advances in the treatment
of the patient with colorectal disease. We hope that it also stimulates the in-
quisitive nature of future generations of colorectal specialists.

Robin P. Boushey, BSc, MD, PhD, CIP, FRCSC

Department of Colon and Rectal Surgery
Division of General Surgery
Ottawa Health Research Institute
The Ottawa Hospital
University of Ottawa
501 Smyth Road, Room 2003
Ottawa, Ontario K1H 8L6, Canada
E-mail address:

Patricia L. Roberts, MD
Department of Colon and Rectal Surgery
Lahey Clinic
41 Mall Road
Burlington, MA 01805, USA
E-mail address: