What are the pros and cons of laparoscopic versus open colectomy? Pro • Smaller incisions • Less pain medication • Quicker recovery and return to work • Possible earlier return of bowel function Con • Steep learning curve for technical proficiency • Increased difficulty in reoperative setting or with acute inflammation (diverticulitis)
Does laparoscopic surgery compromise the chance for a cure? No. Several prospective randomized studies have demonstrated equivalent cancer survival from both open and laparoscopic approaches. The key to achieving this is to conduct the same extent of resection either way. Initial concerns for development of port site metastasis are unfounded.
What are the fundamental principles of colon resection for cancer? • A 5-cm margin on either side of the tumor • Vascular supply taken at the origin of the closest named vessel (ileocolic, right colic, middle colic, left colic, inferior mesenteric artery) • Adequate lymph node staging (generally aim for a minimum of 12 nodes evaluated )
What are the indications for neoadjuvant (before surgery) and adjuvant (after surgery) therapy? Any N1 or T4 disease indicates the need for therapy. It is generally indicated for uT3 lesions and some uT2 lesions. Neoadjuvant therapy decreases local recurrence rates and improves chances for sphincter preservation.
What is an abdominal perineal resection (APR), and when is it indicated? APR is the removal of the entire anus and rectum with an end colostomy. It is generally indicated for total anal incontinence or tumors that invade the anal sphincter. Low rectal cancers that do not directly invade the anal sphincter can, in certain …
When is endoscopic mucosal resection indicated? EMR is indicated in the presence of large benign polyps and some T1 tumors. Those with adverse features such as lymphovascular invasion and positive margins need additional therapy such as full-thickness (surgical) excision or radiotherapy.
What is the best way to stage rectal cancer? It has been said that an educated finger is the best instrument; however, the overall accuracy of staging depends on the information desired and the modality chosen. Staging guidelines are outlined in the below table; however, operator experience and judgment remain invaluable. Estimated Accuracy of Rectal Cancer …