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home - Colon - Colorectal and Anal Cancer - Colorectal Cancer Surgery Written by Dr Sebastian Zeki
Knowledge

Knows the pathology of benign and malignant tumours of the colon
and rectum
Has awareness of the molecular genetics of colorectal
carcinogenesis and the adenoma-carcinoma sequence
Knows the range of predisposing conditions including inherited
syndromes and acquired colonic diseases
Knows the range of clinical presentation and the means of
diagnosis, investigation, management and follow-up
Knows the strategy for prevention including procedures for
screening

Skills
Uses clinical assessment and selects investigations to reach a rapid
conclusion as to whether a patient might have colorectal cancer and
arranges timely investigation.
Refers the patient to the multi-disciplinary team CbD, mini-CEX,

Behaviours
Shows ability to react to possible diagnosis of malignancy in a timely
manner

Communicates with patient and family in a sympathetic and
understanding manner, explains next steps, involves other health
professionals (including the GP) as appropriate

Colorectal Cancer Surgery

Goal of Surgery for Colorectal Cancer: -Complete removal of the tumour.-Removal of vascular pedicle feeding the affected colonic segment.-Removal of lymphatic drainage basin (need at least 12+ any other suspicious LNs, need 5cm resection margin).-En bloc resection of contiguous structures if tumour adhesion is present.-Mark with radioopaque clips if RT anticipated (don’t disrupt adhesion plane can seed, and place omentum in post-op bed). MorbidityProlonged ileus (7.5 %);Pneumonia (6.2 %);Failure to wean from the ventilator (5.7 %); UTI(5 %);30 hospital mortality 6%. Short-term bowel function — BO increas to 4x/day. Usually beomes normal after 6 month Laparoscopic Colectomy:Less pain, faster return of bowel function, and shorter hospital stay10-20% convert to open. Principles of Surgery For Colorectal Cancer Criteria for surgery instead of endoscopic resecton:Poorly differentiated histology.Lymphovascular invasion. Cancer at the resection or stalk margin. Invasion into the muscularis propria of the bowel wall (T2 lesion). Invasive carcinoma arising in a sessile (flat) polyp. Invasive carcinoma with incomplete polypectomy. Management of Cancer in a Polyp: -If obstructed need temporary colostomy-If perforated usually divert-Ostomy closure when patient stable and if no chemo planned -Colonoscopy if bowel not adequately inspected at op-Bowel prep and oophorectomy not needed Indications For laporoscopic surgery:Nodiseaseinrectumorprohibitiveabdominaladhe-sions.Noadvancedlocalormetastaticdisease.No acutebowelobstructionorperforationfromcancer.Thoroughabdominalexplorationisrequired.Considerpreoperativemarkingofsmalllesions. Written by Dr Sebastian Zeki

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