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Colorectal Surgery
Published in Tjun Tang, Elizabeth O'Riordan, Stewart Walsh, Cracking the Intercollegiate General Surgery FRCS Viva, 2020
Jennie Grainger, Samson Tou, Steve Schlichtemeier, William Speake, Fung Joon Foo, Frank McDermott
What are the surgical options and what would you mention in your counselling?Ultra-low anterior resection: oncologically the most definitive option. Disadvantages include perioperative risks of rectal resections and functional problems related to low rectal resections.Full thickness local excision (TEMS, TAMIS, TEO): As it is a T1 tumour, we can consider local excision.
Surgical Principles: Bowel Anastomosis, Wound Management and Surveillance
Published in Peter Sagar, Andrew G. Hill, Charles H. Knowles, Stefan Post, Willem A. Bemelman, Patricia L. Roberts, Susan Galandiuk, John R.T. Monson, Michael R.B. Keighley, Norman S. Williams, Keighley & Williams’ Surgery of the Anus, Rectum and Colon, 2019
The importance of such thorough prior planning of a surgical strategy pre-operatively cannot be over-emphasised. Many surgeons find it useful before the start of an operation to have vocalised to the team not only their ‘plan A’ but also specific circumstances that would lead to a change to ‘plan B’ or ‘plan C’. For example, under what circumstances would a planned low anterior resection require conversion to an abdomino-perineal excision of rectum? Or what predictable difficulty would result in conversion from a laparoscopic resection to an open one and what impact would that have on post-operative recovery? The popularisation of the WHO checklist is likely to see such an approach become widespread.31 Not only should it crystallise the thoughts of the lead surgeon about how to respond if a particular intraoperative difficulty is encountered, but it also engages the rest of the theatre team with the challenges that might be encountered and how they might be required to adapt. The role communication and other non-technical skills play in ensuring a good outcome within the operating room is now more widely appreciated.
The rectum
Published in Professor Sir Norman Williams, Professor P. Ronan O’Connell, Professor Andrew W. McCaskie, Bailey & Love's Short Practice of Surgery, 2018
Professor Sir Norman Williams, Professor P. Ronan O’Connell, Professor Andrew W. McCaskie
The bowel is usually prepared by mechanical cleansing using a combination of diet, purgatives and enemas to reduce intraoperative contamination and the risk of surgical site infection. This approach is now used more selectively, with many surgeons reserving full bowel preparation for those undergoing a low anterior resection.
Temporal Changes of Low Anterior Resection Syndrome Score after Sphincter Preservation: A Prospective Cohort Study on Repetitive Assessment of Rectal Cancer Patients
Published in Journal of Investigative Surgery, 2022
George E. Theodoropoulos, Artemis Liapi, Basileios G. Spyropoulos, Eleni Kourkouni, Maximos Frountzas, George Zografos
There is an abundance of literature data on the postoperative prevalence of LARS focusing on patients’ assessments at various follow-up time-points, even at the long-term, taking into account relevant patients and surgery- related risk factors that may be implicated at the aggravation of bowel dysfunction [7–18]. However, scarce evidence still exists on how the LARS prospectively evolves over the postoperative period on an individualized basis, patient per patient, and to what extent the implicating, easily identifiable, clinical factors affect the postoperative natural history of LARS. Only one study utilized repeated and at fixed postoperative intervals assessment of bowel dysfunction symptoms [19]. That was, though, a retrospective search of self-reported low anterior resection-related symptoms and no validated questionnaire was used [19]. Using a longitudinal design, a Northern European group assessed the LARS score at two distinct time-points with 5 years of difference in-between, aiming at revealing if major changes occur at the same patients [20]. Nevertheless, despite its prospective design, this study did not aim at evaluating the patients at pre-fixed time-points [20]. In an effort to cover literature data shortage on repetitive LARS assessment at the same cohort of patients using the validated LARS score on pre-fixed postoperative time intervals, we prospectively investigated the occurrence of LARS after rectal cancer sphincter preserving surgery and we attempted to reveal the effect of identified risk factors to LARS score-determined subgroups.
Evolution in the management of soft tissue sarcoma: classification, surgery and use of radiotherapy
Published in Expert Review of Anticancer Therapy, 2020
Angelo Paolo Dei Tos, Sylvie Bonvalot, Rick Haas
European experience indicates that surgery of locally advanced GIST, or GIST requiring mutilating surgery, should be performed when clinical response is maximal after 6–12 months of preoperative imatinib therapy and further improvement is absent based on two consecutive imaging scans [56]. This patient underwent a low anterior resection in May 2017. Pathology showed a tumor 20 × 30 mm in size with a minimal inferior margin of 5 mm and a lateral minimum margin of 1 mm. Microscopic determination of the mitotic index showed 2 mitoses per 50 cells in a high-power field. Metastatic risk of GIST is based on initial characteristics of the tumor prior to treatment, taking into account its size and location [57]. On biopsy, mitotic count is not representative and, after treatment, is no more informative than initial characteristics. Applying these criteria (size and location), adjuvant imatinib therapy was clearly indicated [46]. For anorectal GIST following resection, tumor size (<5 cm) is the most important determinant of survival [58].
Survival following rectal cancer surgery: does the age matter?
Published in Acta Chirurgica Belgica, 2019
Yahya Al-Abed, Michael Parker, Tan Arulampalam, Matthew Tutton
At Colchester Hospital University an efficient enhanced recovery program is run with robust prospectively collected data on all patients undergoing colorectal cancer resections. Over a ten-year period from January 2005 to December 2014, a retrospective analysis of the prospectively collected data on all patients who underwent radical rectal cancer surgery was performed. Patients who had rectal cancer surgery were identified by those undergoing an anterior resection, low anterior resection, ultralow anterior resection and abdominoperineal resection. To avoid including sigmoid cancers, the data was correlated with the final histological diagnosis and exclusions applied accordingly. Data collected were patient demographics, clinical data, age, sex, neo-adjuvant cancer treatment, cancer Duke’s stage, Cancer TNM staging, stoma status, post-operative complications and mortality including long term survival follow-up. TNM Cancer staging was available for 335 out of the 374 patients and the remaining 39 patients were assigned to the category “None.” Duke’s cancer classification was available for 335 patients. Patients with missing values for other essential variables, such as histology results or survival indicators, were excluded from the study.