LAPAROSCOPIC MANAGEMENT OF COLORECTAL CANCER

Abstract

Colorectal cancer is the third most common form of cancer and the second leading cause of cancer-related death in the western world. Surgery is the main treatment for colorectal cancer. Among all available treatment modalities, surgical intervention provides the most rapid relief of symptoms associated with colorectal cancer, including symptoms arising due to bleeding, obstruction, perforation and fistulation into surrounding organs. Radical surgical resection for colorectal cancer follows the following three principles: En-bloc resection of the tumor with adequate margins-Resection of drainage lymph nodes for staging-Intraoperative assessment of the liver and peritoneal cavity for staging. For elective operation of patients with non-obstructing cancer, bowel preparation aiming at clearing the large bowel of faecal matter prior to surgery is often performed. Bowel preparation consists of two parts: Dietary restriction or Mechanical bowel preparation –Prophylactic Antibiotics. The major surgical procedures for the colon include right hemicolectomy, extended right hemicolectomy, extended left hemicolectomy, left hemicolectomy, rectosigmoid resection. Compared with the conventional approach, laparoscopic resection has the advantages of less blood loss, less wound infection, less wound pain, faster postoperative recovery and better-looking wound. Tumors located in the appendix, cecum, or ascending colon often require a right hemicolectomy, the anatomic boundaries of which span the cecum to the proximal half of the transverse colon. An extended right hemicolectomy includes the transverse colon to the splenic flexure that includes the left branch of the middle colic artery. This procedure is appropriate for tumors at the hepatic flexure and the transverse colon. The planned resection for right hemicolectomy includes the final 6 cm of the ileum and the proximal transverse colon. Tumors of the cecum should include 10–15 cm of the ileum. The ileocolic, right colic, and right branch of the middle colic vessels are ligated at their origins and the mesentery removed with the colon. Tumors of the distal transverse colon, splenic flexure, descending colon require a left hemicolectomy. The left hemicolectomy specimen includes the distal transverse colon and the descending colon down to 2–3 cm above the sacral promontory. A subtotal colectomy for cancer consists of removal of the entire intraperitoneal colon, and is often required for multiple polyps that are not amenable to endoscopic resection or the presence of synchronous tumors. For many years, an operation proposed by Miles combined a radical abdominal and perineal approach for the surgical resection of rectal carcinoma. The abdominoperineal resection (APR) with a permanent colostomy was the gold standard for rectal tumors from the anal verge to 15 cm above the anal verge. The goals of surgery for rectal cancer include: • Cure – This involves complete en bloc resection of the primary cancer and prevention of systemic spread • Local control – to avoid pelvic recurrence • Sphincter preservation – restoration of continuity and preservation of anorectal function • Preservation of sexual and urinary function – preserving the integrity of pelvic autonomic nervous system.