Colorectal Cancer

Colorectal Cancer

Colorectal cancer is the third most frequent cancer in men and the second in women. Most neoplasms of the colon and rectum originate from polyps not known to the patient and therefore not removed that over the years become real neoplasms.

Once the diagnosis of neoplasia is obtained, the staging is completed with the most appropriate examinations of the case (CT chest-abdomen, MRI, EUS, etc.) and the patient is taken care of in full for the treatment of his disease. A new diagnosis of colorectal neoplasia is therefore discussed in a multidisciplinary setting, i.e. among Surgeons, Gastroenterologists and Oncologists together with colleagues from Pathology, Radiology and Radiotherapy. The purpose of this discussion is the attempt to offer the patient the best available treatment involving the various specialists of the case.

In a very general way, it can be said that the treatment of neoplasms of the colon is generally different from that of neoplasms of the rectum. Most neoplasms of the colon are approached primarily by the surgeon and then according to the outcome of the histological examination of the piece removed the patient is subjected or not to a possible systemic chemotherapy. With regard to neoplasms of the rectum, on the other hand, often the patient is initially treated by colleagues oncologists and radiation oncologists and then is referred to the surgeon for the execution of surgery to remove the rectum. The type of surgery varies in relation to the site of the tumor.

At the Poliambulanza Foundation Hospital, my colleagues and I operate on the vast majority of patients with minimally invasive techniques, that is, through the laparoscopic or robotic approach. The laparoscopic approach consists of operating inside the patient's abdomen through a few small incisions and with the use of a video camera and some specially dedicated long forceps.

The robotic approach, on the other hand, consists of the use of the da Vinci Xi Robot (the latest model currently available on the market) which is connected to the patient by means of articulated arms and is controlled by the surgeon working at a console a few meters away from the patient. In some selected cases, in addition to the classic intervention performed via the abdomen, it is also necessary to perform a transanal approach, or from the anus through techniques defined as TEM/TAMIS/TATME. These interventions are, however, carried out entirely minimally invasive. Only in a few rare cases the traditional technique with abdominal incisions is used. Among the various advantages of laparoscopy and the use of the Robot are a smoother and faster postoperative course, less pain and fewer complications.

Recently we have introduced the use of indocyanine green, a vital intraoperative dye, which helps the surgeon in some important therapeutic choices through the use of a dedicated camera and has the function of reducing the surgical complications normally related to the surgery itself. In some cases, it is necessary to know that it is indicated to "protect" the anastomosis (the union of the two stumps of the intestine once the segment of the colorectum containing the tumor has been removed), temporarily diverting the transit of stool to the outside with the packaging of an ostomy. This is done in selected cases and the patient is always informed prior to surgery about this risk.

The ostomy is generally temporary and intestinal continuity is re-established with a second surgical intervention a few months after the first one. On the other hand, in rare cases, given the localization of the neoplasm in the lower part of the rectum, it is necessary to proceed to the total removal of the entire rectum and to the creation of a permanent ostomy.

Patients operated on for colorectal neoplasms in Fondazione Poliambulanza are included in the protocols for the clinical management of patients, which has the function of speeding up the postoperative recovery of the patient so as to obtain a more rapid return to their daily lives.


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Prof. Mohammad Abu Hilal is the Director of the Department of General Surgery and Head of the Hepatobiliopancreatic, Robotic and Minimally Invasive Surgery Unit at Fondazione Poliambulanza.

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