This document summarizes the management of colorectal cancer from the perspective of a colorectal surgeon. Key points discussed include the importance of total mesorectal excision surgery, developments in less invasive surgical techniques like laparoscopic surgery, the roles of radiotherapy and chemotherapy, and the increased focus on sphincter preservation and quality of life outcomes for patients. Advances in staging techniques such as endorectal ultrasound and MRI are also reviewed.

1. 21 ST CENTURY MANAGEMENT OF COLORECTAL CANCER – A SURGEON’S VIEW Andrew Luck Colorectal Surgeon Northern Adelaide Colorectal Unit Adelaide, South Australia Honorary Secretary, Colorectal Surgical Society of Australia and New Zealand CSSANZ representative, National Bowel Cancer Screening Program Advisory Group CANCER SOCIETY OF NEW ZEALAND, WELLINGTON June 2009

5. DYE SPRAY

7. NARROW BAND IMAGING

10. WITHDRAWAL TIMES

12. BARIUM ENEMA

17. ENDORECTAL ULRASOUND

19. Copyright © 2007 by the American Roentgen Ray Society Kim, M.-J. et al. Am. J. Roentgenol. 2004;182:1469-1476 --72-year-old man with polypoid rectal carcinoma extending to submucosa

20. Copyright © 2007 by the American Roentgen Ray Society Kim, M.-J. et al. Am. J. Roentgenol. 2004;182:1469-1476 --59-year-old woman with ulcerative carcinoma extending beyond proper muscle layer

23. THE HOLY PLANE

26. COLONIC J POUCH

38. COLONIC STENTS

39. COLONIC STENTS

40. COLONIC STENTS

41. COLONIC STENTS

42. COLONIC STENTS 84 88 F 80 Camunez (2000) 90 90 F 71 Mainar (1999) 90 100 F 10 Wholey (1998) 100 100 F 12 Diaz (1998) 96 100 F 24 DeGregorio (1998) 75 90 E+F 20 Choo (1998) 84 92 E+F 25 Baron (1996) 80 80 E+F 15 Saida (1996) 92 92 E 12 Rey (1995) 85 92 E 13 Spinelli (1993) Clinical success (%) Technical success (%) Guidance No. patients

44. TRANSANAL ENDOSCOPIC MICROSURGERY

45. TRANSANAL ENDOSCOPIC MICROSURGERY