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Laparoscopic Hemicolectomy for Left Colon Cancer
Published in Haribhakti Sanjiv, Laparoscopic Colorectal Surgery, 2020
Ashwin deSouza, Shankar Malpangudi
The surgical approach for rectal resection witnessed a paradigm shift in 1979 with the introduction of total mesorectal excision [20]. Adopting this technique of resecting the rectum by sharp dissection, and maintaining an intact mesorectal fascial envelope was associated with dramatic decreases in local recurrence and an improvement in survival [20,21]. Hohenberger et al. proposed a similar approach for radical colectomy which involved mobilization of the colon along the embryological fascial planes, maintaining an intact mesocolic fascia, ensuring a complete lymphadenectomy of all the nodal tissue, and dividing the supplying vessels at their origin [22]. Adopting this technique, the Erlangen group was able to show a decrease in local recurrence rates and an improvement in cancer-related survival [22].
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 is a total mesorectal excision?This is precise dissection in an areolar plane between visceral fascia (envelopes rectum and mesorectum) and parietal fascia (overlying pelvic structures).It was popularised by Professor Heald from Basingstoke.It leaves an intact mesorectum, and the best opportunity for negative CRM and distal margins.Local recurrence is 3% (5 years) and survival is 80%.It should be performed for all mid-rectal and low rectal cancers, including APER, often with APER however the addition of a levator wrap is considered (extra Levator APER).
Gastrointestinal cancer
Published in Peter Hoskin, Peter Ostler, Clinical Oncology, 2020
Rectal cancer surgery is total mesorectal excision. In stage II and III tumours preoperative chemoradiation is taken. In selected cases total mesorectal excision (TME) alone may be sufficient; low risk cases suitable for this are defined by T1N0 tumours, <3 cm diameter occupying <30% of the circumference and with well or moderately differentiated histology.
Effect of Glutamine on Short-term Surgical Outcomes in Rectal Cancer Patients Receiving Neoadjuvant Therapy: A Propensity Score Matching Study
Published in Nutrition and Cancer, 2023
Gang Tang, Feng Pi, Zhengqiang Wei, Xiangshu Li
Colorectal cancer, one of the most common malignant tumors worldwide, has an estimated incidence of more than 1.8 million cases every year. Rectal cancers comprise nearly 40% of these cases and are primarily treated by surgical interventions (1, 2). The advent of total mesorectal excision has greatly improved the oncologic prognosis of patients with rectal cancer (3). However, given that most patients receive an initial diagnosis only after the development of locally advanced disease due to lack of obvious clinical symptoms, the efficacy of surgical treatment in isolation is limited. In view of the fact that preoperative chemoradiotherapy is known to reduce tumor stage and local recurrence rate, as well as increase the radical resection rate (4, 5), neoadjuvant chemoradiotherapy in combination with total mesorectal excision has become the standard treatment for locally advanced rectal cancers (3). Certain studies, however, highlight the damage to the local intestinal wall tissue as well as an increased incidence of postoperative complications as consequences of neoadjuvant therapy (6, 7). A recent metastudy revealed the association between the increased incidence of pelvic abscess, anastomotic leakage, and wound infection and neoadjuvant radiotherapy (3). Such complications not only increase the economic burden on patients, but also negatively affect their cancer prognosis (8, 9). Therefore, the development of strategies to reduce the incidence of postoperative complications in rectal cancer patients receiving neoadjuvant therapy has become a research hotspot.
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
The standard operative technique included total mesorectal excision in patients with tumors in the lower and mid rectum, and partial mesorectal excision with transection of the mesorectum at least 5 cm distal to the tumor in patients with cancer of the upper rectum. All patients were subjected to low anterior resections, with opening of the anterior peritoneal reflection and construction of the anastomosis at the lowest edge of the mid rectum for upper rectal cancer cases and the low rectum, the apex of anal canal or intra-anally for mid and low rectal cancer cases. A defunctioning “protective” loop ileostomy was constructed in the majority of the cases where a low-lying anastomosis was necessary; most of the ileostomies were reversed after the end of the adjuvant chemotherapy, except for the cases where adjuvant treatment was not deemed necessary or not accepted by patient, the ileostomies were closed at an average of 2 months postoperatively.
Triumph against cancer: invading colorectal cancer with nanotechnology
Published in Expert Opinion on Drug Delivery, 2021
Preksha Vinchhi, Mayur M. Patel
Surgical approach for the treatment of colon cancer includes Colectomy i.e. surgical removal of the part of the colon or full colon (depending on the tumor spread) and en bloc resection of surrounding lymph nodes. Colectomy can be termed as hemicolectomy, segmental resection or partial colectomy in the case of the removal of only some part of the colon, while removal of the whole colon is called total colectomy. Either open surgery or laparoscopic resection can be done to perform colectomy. Even though laparoscopic surgery is found to be as safe as open surgery, there are some limitations associated with laparoscopic surgery like problems associated due to previous abdominal surgeries, advanced disease stage, obesity, etc [22,39]. Loop colostomy or permanent colostomy is often required in which a stoma is formed for diverting feces in a bag placed outside the body. Avoiding the need for permanent colostomy is an essential target to be achieved by surgeons. However, employing highly precise surgical techniques and recent stapling devices, the permanent colostomy can be generally avoided except when the anal sphincter is also involved in very low rectal tumors. The surgical procedure widely used in the treatment of rectal cancer is total mesorectal excision (TME) that includes removal of rectum, mesorectum, and mesorectal fascia. Surgical procedures like laparoscopy-assisted TME, transanal excision, low anterior resection, abdominoperineal resection, coloanal anastomosis, proctectomy, etc. are also employed depending on the location of the tumor [40].