Colorectal cancer surgery: Difference between revisions
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__NOTOC__ | __NOTOC__ | ||
{{Colon cancer}} | {{Colon cancer}} | ||
''' | To view the surgery of familial adenomatous polyposis (FAP), click [[Familial adenomatous polyposis surgery|'''here''']]<br> | ||
To view the surgery of hereditary nonpolyposis colorectal cancer (HNPCC), click [[Hereditary nonpolyposis colorectal cancer surgery|'''here''']]<br><br> | |||
{{CMG}} {{AE}} Elliot B. Tapper, M.D., Saarah T. Alkhairy, M.D. | |||
==Overview== | ==Overview== | ||
Surgery remains the primary treatment while chemotherapy and/or radiotherapy may be recommended depending on the individual patient's staging and other medical factors. | Surgery remains the primary treatment while chemotherapy and/or radiotherapy may be recommended depending on the individual patient's staging and other medical factors. | ||
==Surgery== | ==Colorectal Cancer Surgery== | ||
Surgeries can be categorised into curative, palliative, bypass, | Surgeries can be categorised into curative, palliative, bypass, open-and-close, or laparoscopic surgical treatment. | ||
===Curative [[Surgery|Surgical]] Treatment=== | |||
* Very early cancer that develops within a [[polyp]] can often be cured by removing the polyp (i.e., polypectomy) at the time of [[colonoscopy]] | *This surgical treatment can be offered if the tumor is localized | ||
* In colon cancer, a more advanced tumor typically requires surgical removal of the section of colon containing the tumor with sufficient margins, and radical en-bloc resection of [[mesentery]] and [[lymph node]]s to reduce local recurrence | *Very early cancer that develops within a [[polyp]] can often be cured by removing the polyp (i.e., polypectomy) at the time of [[colonoscopy]] | ||
* Curative surgery on rectal cancer includes [[total mesorectal excision]] ([[lower anterior resection]]) or [[abdominoperineal excision]] | *In colon cancer, a more advanced tumor typically requires surgical removal of the section of colon (i.e., colectomy) containing the tumor with sufficient margins, and radical en-bloc resection of [[mesentery]] and [[lymph node]]s to reduce local recurrence | ||
:*If possible, the remaining parts of colon are [[anastomosis|anastomosed]] together to create a functioning colon, otherwise a [[stoma (medicine)|stoma]] is created | |||
*Curative surgery on rectal cancer includes [[total mesorectal excision]] ([[lower anterior resection]]) or [[abdominoperineal excision]] | |||
===Palliative Surgical Treatment=== | |||
*In case of multiple metastases, a palliative [[resection]] of the primary tumor is still offered to reduce further [[morbidity]] | |||
*Surgical removal of isolated liver metastases is common and may be curative | |||
===Bypass Surgical Treatment=== | |||
*If the tumor invaded adjacent vital structures which makes [[excision]] technically difficult, surgeons may prefer to bypass the tumor (ileotransverse bypass) or to do a proximal fecal diversion through a [[stoma (medicine)|stoma]] | |||
===Open-and-close Surgical Treatment=== | |||
*If the surgeons find the tumor unresectable and the small bowel is involved, any more procedures would do more harm than good to the patient *This is uncommon with laparoscopy and better radiological imaging | |||
*Most of these cases formerly subjected to "open and close" procedures are now diagnosed in advance and surgery is avoided | |||
===Laparoscopic-assisted Colectomy=== | |||
* | *This is a [[minimally invasive procedure|minimally-invasive]] technique that can reduce the size of the incision, minimize the risk of infection, and reduce post-operative pain | ||
* | |||
* | ==Complications with Colorectal Surgery== | ||
* [[Adhesion (medicine)|adhesions]] | *Wound [[infection]] | ||
* [[ | *[[Dehiscence]] | ||
* | *Hernia | ||
* Cardiorespiratory complications such as [[myocardial infarction]], [[pneumonia]], [[arrythmia]], [[pulmonary embolism]] | *Anastomosis breakdown, leading to abscess or fistula formation and/or peritonitis | ||
*Bleeding with or without [[hematoma]] formation | |||
*[[Adhesion (medicine)|adhesions]] leading to [[bowel obstruction]] | |||
*[[Blind loop syndrome]] in bypass surgery | |||
*Adjacent organ injury - most commonly to the small intestine, ureters, spleen, or bladder | |||
*Cardiorespiratory complications such as [[myocardial infarction]], [[pneumonia]], [[arrythmia]], or [[pulmonary embolism]] | |||
==References== | ==References== | ||
Revision as of 14:27, 15 July 2015
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Colorectal cancer Microchapters |
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Diagnosis |
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Treatment |
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Case Studies |
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Colorectal cancer surgery On the Web |
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American Roentgen Ray Society Images of Colorectal cancer surgery |
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Risk calculators and risk factors for Colorectal cancer surgery |
To view the surgery of familial adenomatous polyposis (FAP), click here
To view the surgery of hereditary nonpolyposis colorectal cancer (HNPCC), click here
Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1] Associate Editor(s)-in-Chief: Elliot B. Tapper, M.D., Saarah T. Alkhairy, M.D.
Overview
Surgery remains the primary treatment while chemotherapy and/or radiotherapy may be recommended depending on the individual patient's staging and other medical factors.
Colorectal Cancer Surgery
Surgeries can be categorised into curative, palliative, bypass, open-and-close, or laparoscopic surgical treatment.
Curative Surgical Treatment
- This surgical treatment can be offered if the tumor is localized
- Very early cancer that develops within a polyp can often be cured by removing the polyp (i.e., polypectomy) at the time of colonoscopy
- In colon cancer, a more advanced tumor typically requires surgical removal of the section of colon (i.e., colectomy) containing the tumor with sufficient margins, and radical en-bloc resection of mesentery and lymph nodes to reduce local recurrence
- If possible, the remaining parts of colon are anastomosed together to create a functioning colon, otherwise a stoma is created
- Curative surgery on rectal cancer includes total mesorectal excision (lower anterior resection) or abdominoperineal excision
Palliative Surgical Treatment
- In case of multiple metastases, a palliative resection of the primary tumor is still offered to reduce further morbidity
- Surgical removal of isolated liver metastases is common and may be curative
Bypass Surgical Treatment
- If the tumor invaded adjacent vital structures which makes excision technically difficult, surgeons may prefer to bypass the tumor (ileotransverse bypass) or to do a proximal fecal diversion through a stoma
Open-and-close Surgical Treatment
- If the surgeons find the tumor unresectable and the small bowel is involved, any more procedures would do more harm than good to the patient *This is uncommon with laparoscopy and better radiological imaging
- Most of these cases formerly subjected to "open and close" procedures are now diagnosed in advance and surgery is avoided
Laparoscopic-assisted Colectomy
- This is a minimally-invasive technique that can reduce the size of the incision, minimize the risk of infection, and reduce post-operative pain
Complications with Colorectal Surgery
- Wound infection
- Dehiscence
- Hernia
- Anastomosis breakdown, leading to abscess or fistula formation and/or peritonitis
- Bleeding with or without hematoma formation
- adhesions leading to bowel obstruction
- Blind loop syndrome in bypass surgery
- Adjacent organ injury - most commonly to the small intestine, ureters, spleen, or bladder
- Cardiorespiratory complications such as myocardial infarction, pneumonia, arrythmia, or pulmonary embolism