Pub Date : 2021-10-31DOI: 10.5772/intechopen.100112
Enio Chaves Oliveira, M. Bafutto, Alexandre Augusto Ferreira Bafutto, Salustiano Gabriel Neto, Jarbas Jabur Bittar Neto
The incidence of inflammatory bowel disease (IBD) is increasing world-wide and most patient will require some surgical treatment once in life. IBD surgical patients are a challenge to surgeons. Main goals of surgical treatment are (1) to preserve the small bowel integrity because many resections may lead the patient to a small bowel short syndrome and (2) restore normal function as they have absorption disturbances. IBD patients may present mal-nutrition status and/or immunosuppression at the time of surgery. Types of surgery range from a simple plasty in Crohn disease to a total proctocolectomy in Ulcerative Colitis. For Crohn disease most procedures avoid resection and use diseased segments to prevent disabsorption. Herein we describe the most currently used techniques to treat IBD patients, when to indicate surgery and how to prepare them to less outcomes. Patients with Crohn disease with high risk for short bowel syndrome and intestinal failure should be submitted to Strictureplasty otherwise, Bowel Resection is the favored surgical technique for the management of fibrostenotic. Bowel Resection is associated with lower recurrence rate and longer recurrence-free survival.
{"title":"Current Elective Surgical Treatment of Inflammatory Bowel Disease","authors":"Enio Chaves Oliveira, M. Bafutto, Alexandre Augusto Ferreira Bafutto, Salustiano Gabriel Neto, Jarbas Jabur Bittar Neto","doi":"10.5772/intechopen.100112","DOIUrl":"https://doi.org/10.5772/intechopen.100112","url":null,"abstract":"The incidence of inflammatory bowel disease (IBD) is increasing world-wide and most patient will require some surgical treatment once in life. IBD surgical patients are a challenge to surgeons. Main goals of surgical treatment are (1) to preserve the small bowel integrity because many resections may lead the patient to a small bowel short syndrome and (2) restore normal function as they have absorption disturbances. IBD patients may present mal-nutrition status and/or immunosuppression at the time of surgery. Types of surgery range from a simple plasty in Crohn disease to a total proctocolectomy in Ulcerative Colitis. For Crohn disease most procedures avoid resection and use diseased segments to prevent disabsorption. Herein we describe the most currently used techniques to treat IBD patients, when to indicate surgery and how to prepare them to less outcomes. Patients with Crohn disease with high risk for short bowel syndrome and intestinal failure should be submitted to Strictureplasty otherwise, Bowel Resection is the favored surgical technique for the management of fibrostenotic. Bowel Resection is associated with lower recurrence rate and longer recurrence-free survival.","PeriodicalId":211064,"journal":{"name":"Current Topics in Colorectal Surgery [Working Title]","volume":"128 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2021-10-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"116717770","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2021-10-26DOI: 10.5772/intechopen.99269
Eng (Eric) Kiat Yeoh
Chronic radiation proctitis (CRP), characterized by increased frequency and urgency of defecation, fecal incontinence and rectal bleeding, is an under-estimated cause of morbidity after pelvic irradiation for urological and gynecological malignant diseases. Despite improvements in radiotherapy technology, 90% of patients have persistent long term symptoms and 50% of all patients report impairment of quality of life after pelvic radiotherapy. Research by an Australian group of clinician scientists, including prospective, longitudinal and retrospective studies as well as a randomized trial of two current approaches used for the treatment of haemorrhagic radiation proctitis over a time span exceeding two decades, have provided important insights into the prevalence, pathophysiology natural history and treatment of CRP. The findings have important implications for the management and amelioration if not prevention of CRP. Data from 4 selected studies conducted by the Australian group, each characterizing changes in anorectal function and anal sphincteric morphology, are first presented. This is followed by discussion of how the findings have led to the development of more rational therapeutic interventions for CRP and how novel approaches designed to reduce the prevalence of CRP when combined could lead to its elimination in the foreseeable future.
{"title":"Pathophysiology, Natural History and Approaches to Treatment and Prevention of Radiation Proctitis","authors":"Eng (Eric) Kiat Yeoh","doi":"10.5772/intechopen.99269","DOIUrl":"https://doi.org/10.5772/intechopen.99269","url":null,"abstract":"Chronic radiation proctitis (CRP), characterized by increased frequency and urgency of defecation, fecal incontinence and rectal bleeding, is an under-estimated cause of morbidity after pelvic irradiation for urological and gynecological malignant diseases. Despite improvements in radiotherapy technology, 90% of patients have persistent long term symptoms and 50% of all patients report impairment of quality of life after pelvic radiotherapy. Research by an Australian group of clinician scientists, including prospective, longitudinal and retrospective studies as well as a randomized trial of two current approaches used for the treatment of haemorrhagic radiation proctitis over a time span exceeding two decades, have provided important insights into the prevalence, pathophysiology natural history and treatment of CRP. The findings have important implications for the management and amelioration if not prevention of CRP. Data from 4 selected studies conducted by the Australian group, each characterizing changes in anorectal function and anal sphincteric morphology, are first presented. This is followed by discussion of how the findings have led to the development of more rational therapeutic interventions for CRP and how novel approaches designed to reduce the prevalence of CRP when combined could lead to its elimination in the foreseeable future.","PeriodicalId":211064,"journal":{"name":"Current Topics in Colorectal Surgery [Working Title]","volume":"59 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2021-10-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"115735846","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2021-10-15DOI: 10.5772/intechopen.100411
Sinziana Ionescu
Intraoperative ultrasound (IOUS) in colorectal surgery can be used both in benign and in malignant lesions. In benign cases, such as Crohn’s disease and diverticulitis, it can orient toward the extension of the surgical intervention. In malignant cases, such as colorectal cancer with liver metastases, IOUS/CE-IOUS (contrast-enhanced) improved the intraoperative management of liver metastases by dictating the resection margins in relation to the tumor extension. The IOUS method allows for exact tumor location, intestinal wall visualization, and malignant tumor penetration. The IOUS revealed the tumor and its margin in rectal lesions, making the sphincter-sparing operation easier to perform. In patients with small polyps and early colon and rectum cancers, IOUS works well as a one-of-a-kind intraoperative localization technique. In comparison with IOUS, CE-IOUS offered better detection and resection guidance. Intraoperative ultrasound enables surgeons to easily localize small, non-palpable lesions of the large bowel. Furthermore, it can determine even the aggressive potential of these lesions with high precision.
{"title":"Intraoperative Ultrasound in Colorectal Surgery","authors":"Sinziana Ionescu","doi":"10.5772/intechopen.100411","DOIUrl":"https://doi.org/10.5772/intechopen.100411","url":null,"abstract":"Intraoperative ultrasound (IOUS) in colorectal surgery can be used both in benign and in malignant lesions. In benign cases, such as Crohn’s disease and diverticulitis, it can orient toward the extension of the surgical intervention. In malignant cases, such as colorectal cancer with liver metastases, IOUS/CE-IOUS (contrast-enhanced) improved the intraoperative management of liver metastases by dictating the resection margins in relation to the tumor extension. The IOUS method allows for exact tumor location, intestinal wall visualization, and malignant tumor penetration. The IOUS revealed the tumor and its margin in rectal lesions, making the sphincter-sparing operation easier to perform. In patients with small polyps and early colon and rectum cancers, IOUS works well as a one-of-a-kind intraoperative localization technique. In comparison with IOUS, CE-IOUS offered better detection and resection guidance. Intraoperative ultrasound enables surgeons to easily localize small, non-palpable lesions of the large bowel. Furthermore, it can determine even the aggressive potential of these lesions with high precision.","PeriodicalId":211064,"journal":{"name":"Current Topics in Colorectal Surgery [Working Title]","volume":"31 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2021-10-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"128713836","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2021-10-15DOI: 10.5772/intechopen.100302
Sînziana Ionescu
Colorectal anastomosis is defined as a surgical procedure in which the colon is attached to the remainder of the rectum after most or some part of it was removed during an intervention. A straight colorectal anastomosis implies a direct attachment, while a J-pouch colorectal anastomosis implies a previous creation of a reservoir, or “pouch” out of bowel material. The problem of colorectal anastomosis safety and outcome is among the most important and persistent issues in colorectal surgery, mainly due to the anastomotic leakage, a threatening and dangerous complication, with an incidence of up to 20% or even more in case of surgical oncology. Various prediction models and anastomosis testing techniques have been described in order to prevent or identify early any possible imperfection of the anastomosis, each with pros and cons. The measures generally used to increase the safety and reliability of the colorectal anastomosis are to evaluate the blood supply of the tissues anastomosed with indocyanine green, or to test the mechanical integrity of the anastomosis for leakage by employing air, methylene blue, or tension.
{"title":"The Problem of the Colorectal Anastomosis","authors":"Sînziana Ionescu","doi":"10.5772/intechopen.100302","DOIUrl":"https://doi.org/10.5772/intechopen.100302","url":null,"abstract":"Colorectal anastomosis is defined as a surgical procedure in which the colon is attached to the remainder of the rectum after most or some part of it was removed during an intervention. A straight colorectal anastomosis implies a direct attachment, while a J-pouch colorectal anastomosis implies a previous creation of a reservoir, or “pouch” out of bowel material. The problem of colorectal anastomosis safety and outcome is among the most important and persistent issues in colorectal surgery, mainly due to the anastomotic leakage, a threatening and dangerous complication, with an incidence of up to 20% or even more in case of surgical oncology. Various prediction models and anastomosis testing techniques have been described in order to prevent or identify early any possible imperfection of the anastomosis, each with pros and cons. The measures generally used to increase the safety and reliability of the colorectal anastomosis are to evaluate the blood supply of the tissues anastomosed with indocyanine green, or to test the mechanical integrity of the anastomosis for leakage by employing air, methylene blue, or tension.","PeriodicalId":211064,"journal":{"name":"Current Topics in Colorectal Surgery [Working Title]","volume":"15 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2021-10-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"125497722","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2021-10-15DOI: 10.5772/intechopen.100301
Sînziana Ionescu
This chapter looks at the use of indocyanine green (ICG) in colorectal surgery, by exploring at first the definition of vital dyes generally used in the surgical field, afterward the benefits of fluorescence-guided surgery, and furthermore, it enumerates several uses of ICG in the broad surgical field. The identification of tumor nodules in the peritoneum can help with proper cancer staging, and the same advantage is brought by the accurate detection of the sentinel lymph node, which concerns the use of ICG specifically in colorectal surgery, and this can be summed up through the following assets brought by the technique: (a) intraoperative fluorescence angiography as an adjuvant in the process of anastomosis, (b) fluorescence-guided detection of lymph node metastases in colorectal cancer and the sentinel lymph node technique, which was proved better than formal methods in some studies, (c) the positive fluorescence of a liver nodule as small as “only” 200 tumor cells, (d) the help in diagnosing a fistula, (e) the possibility to be used for tumor tattooing also, and (f) the help in maintaining a clean surgical field and preventing wound infection in abdominoperineal resection.
{"title":"The Use of Indocyanine Green in Colorectal Surgery","authors":"Sînziana Ionescu","doi":"10.5772/intechopen.100301","DOIUrl":"https://doi.org/10.5772/intechopen.100301","url":null,"abstract":"This chapter looks at the use of indocyanine green (ICG) in colorectal surgery, by exploring at first the definition of vital dyes generally used in the surgical field, afterward the benefits of fluorescence-guided surgery, and furthermore, it enumerates several uses of ICG in the broad surgical field. The identification of tumor nodules in the peritoneum can help with proper cancer staging, and the same advantage is brought by the accurate detection of the sentinel lymph node, which concerns the use of ICG specifically in colorectal surgery, and this can be summed up through the following assets brought by the technique: (a) intraoperative fluorescence angiography as an adjuvant in the process of anastomosis, (b) fluorescence-guided detection of lymph node metastases in colorectal cancer and the sentinel lymph node technique, which was proved better than formal methods in some studies, (c) the positive fluorescence of a liver nodule as small as “only” 200 tumor cells, (d) the help in diagnosing a fistula, (e) the possibility to be used for tumor tattooing also, and (f) the help in maintaining a clean surgical field and preventing wound infection in abdominoperineal resection.","PeriodicalId":211064,"journal":{"name":"Current Topics in Colorectal Surgery [Working Title]","volume":"7 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2021-10-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"125319299","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2021-10-11DOI: 10.5772/intechopen.100026
C. Duţă, S. Pantea, D. Brebu, A. Dobrescu, C. Lazar, Kitty Botoca, C. Tarta, F. Lazăr
Since a robotic surgical system was developed in the early 1990s and the first robotic-assisted radical prostatectomy was reported in 2001, robotic surgery has spread in many surgical specialties, changing surgical management. Currently, compared to other colorectal procedures, robotic surgery appears to offer great benefits for total mesorectal excision for rectal cancer. Abdominal cavity other procedures such as right hemicolectomy and high anterior resection are relatively uncomplicated and can be performed easily by laparoscopic surgery. First reports have focused on the clinical benefits of robotic rectal cancer surgery compared with laparoscopic surgery. The indications for robotic and laparoscopic rectal cancer surgery are not different. The recently published results of the ROLARR trial, comparing robot-assisted TME to laparoscopic TME, show no advantages of robot assistance in terms of intraoperative complications, postoperative complications, plane of surgery, 30-day mortality, bladder dysfunction, and sexual dysfunction. A drawback of the study is the variability in experience of the participating surgeons in robotic surgery. After correction of this confounder, an advantage for robotic assistance was suggested in terms of risk of conversion to open surgery. For robotic rectal cancer surgery to become the preferred minimally invasive option, it must demonstrate that it does not have the technical difficulties and steep learning curve of laparoscopic surgery. Robotic surgery has several technical advantages over open and laparoscopic surgery. The system provides a stable operating platform, three-dimensional imaging, articulating instruments and a stable surgeon controlled camera which is mainly beneficial in areas where space and maneuverability is limited such as the pelvis.
{"title":"The Robotic Approach in Rectal Cancer","authors":"C. Duţă, S. Pantea, D. Brebu, A. Dobrescu, C. Lazar, Kitty Botoca, C. Tarta, F. Lazăr","doi":"10.5772/intechopen.100026","DOIUrl":"https://doi.org/10.5772/intechopen.100026","url":null,"abstract":"Since a robotic surgical system was developed in the early 1990s and the first robotic-assisted radical prostatectomy was reported in 2001, robotic surgery has spread in many surgical specialties, changing surgical management. Currently, compared to other colorectal procedures, robotic surgery appears to offer great benefits for total mesorectal excision for rectal cancer. Abdominal cavity other procedures such as right hemicolectomy and high anterior resection are relatively uncomplicated and can be performed easily by laparoscopic surgery. First reports have focused on the clinical benefits of robotic rectal cancer surgery compared with laparoscopic surgery. The indications for robotic and laparoscopic rectal cancer surgery are not different. The recently published results of the ROLARR trial, comparing robot-assisted TME to laparoscopic TME, show no advantages of robot assistance in terms of intraoperative complications, postoperative complications, plane of surgery, 30-day mortality, bladder dysfunction, and sexual dysfunction. A drawback of the study is the variability in experience of the participating surgeons in robotic surgery. After correction of this confounder, an advantage for robotic assistance was suggested in terms of risk of conversion to open surgery. For robotic rectal cancer surgery to become the preferred minimally invasive option, it must demonstrate that it does not have the technical difficulties and steep learning curve of laparoscopic surgery. Robotic surgery has several technical advantages over open and laparoscopic surgery. The system provides a stable operating platform, three-dimensional imaging, articulating instruments and a stable surgeon controlled camera which is mainly beneficial in areas where space and maneuverability is limited such as the pelvis.","PeriodicalId":211064,"journal":{"name":"Current Topics in Colorectal Surgery [Working Title]","volume":"7 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2021-10-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"128314782","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2021-10-03DOI: 10.5772/intechopen.100027
Kenneth K.T. Voon
Outcomes of surgical treatment for anorectal abscesses and chronic fistulas varies widely, as there is lack of unified classification and systematic surgical approach to address a wide range of disease pattern. Acute anorectal abscess and chronic fistula-in-ano should be considered the same disease at both end of a spectrum. This article describes in detail the pathogenesis and relevant anorectal anatomy to aid understanding of a new concept of classifying anorectal abscess and fistula based on natural patterns. A better understanding of patterns allows more accurate surgical treatment. Recent evidence shows that definitive surgical treatment for anal fistula during acute abscess stage is safe and feasible. An optimum surgical treatment should focus on eradication of intersphincteric infection, removal of secondary branches or abscesses, allow healing by secondary intention and preserve continence as best as possible. Common challenges faced by clinicians include confusion in classification, inaccurate delineation of fistula, challenging acute abscesses, unable to locate internal opening and facing complex features such as high fistula or multiple branches. Suggested solutions are discussed and a structured treatment strategy according to types and patterns is proposed. Surgical treatment should follow the principles above and combination of surgical techniques is beneficial compared to individual modality.
{"title":"Understanding New Ideas in Cryptoglandular Fistula-in-Ano","authors":"Kenneth K.T. Voon","doi":"10.5772/intechopen.100027","DOIUrl":"https://doi.org/10.5772/intechopen.100027","url":null,"abstract":"Outcomes of surgical treatment for anorectal abscesses and chronic fistulas varies widely, as there is lack of unified classification and systematic surgical approach to address a wide range of disease pattern. Acute anorectal abscess and chronic fistula-in-ano should be considered the same disease at both end of a spectrum. This article describes in detail the pathogenesis and relevant anorectal anatomy to aid understanding of a new concept of classifying anorectal abscess and fistula based on natural patterns. A better understanding of patterns allows more accurate surgical treatment. Recent evidence shows that definitive surgical treatment for anal fistula during acute abscess stage is safe and feasible. An optimum surgical treatment should focus on eradication of intersphincteric infection, removal of secondary branches or abscesses, allow healing by secondary intention and preserve continence as best as possible. Common challenges faced by clinicians include confusion in classification, inaccurate delineation of fistula, challenging acute abscesses, unable to locate internal opening and facing complex features such as high fistula or multiple branches. Suggested solutions are discussed and a structured treatment strategy according to types and patterns is proposed. Surgical treatment should follow the principles above and combination of surgical techniques is beneficial compared to individual modality.","PeriodicalId":211064,"journal":{"name":"Current Topics in Colorectal Surgery [Working Title]","volume":"109 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2021-10-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"117205063","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2021-09-29DOI: 10.5772/intechopen.99547
D. Kršul, D. Karlović, Đ. Bačić, M. Zelić
Complex anal fistulas present a challenge to even a seasoned colorectal surgeon due to high rate of recurrence and a real possibility of fecal incontinence if treated with conventional methods (e.g., fistulotomy, fistulectomy, seton placement). Although the illness is benign in nature, it can significantly decrease patient’s quality of life because of symptoms like pain and soiling. Given those facts, minimally invasive or sphincter preserving methods of treatment were introduced. Some of these include: Video-assisted anal fistula treatment (VAAFT), ligation of intersphincteric fistula tract (LIFT), Fistula-tract laser closure (FILAC), rectal advancement flap (RAF), treatment with platelet cells and combinations of techniques. This chapter would be an overview of these novel techniques with reference to latest clinical trials and meta-analyses.
{"title":"Sphincter Preserving Techniques in Anal Fistula Treatment","authors":"D. Kršul, D. Karlović, Đ. Bačić, M. Zelić","doi":"10.5772/intechopen.99547","DOIUrl":"https://doi.org/10.5772/intechopen.99547","url":null,"abstract":"Complex anal fistulas present a challenge to even a seasoned colorectal surgeon due to high rate of recurrence and a real possibility of fecal incontinence if treated with conventional methods (e.g., fistulotomy, fistulectomy, seton placement). Although the illness is benign in nature, it can significantly decrease patient’s quality of life because of symptoms like pain and soiling. Given those facts, minimally invasive or sphincter preserving methods of treatment were introduced. Some of these include: Video-assisted anal fistula treatment (VAAFT), ligation of intersphincteric fistula tract (LIFT), Fistula-tract laser closure (FILAC), rectal advancement flap (RAF), treatment with platelet cells and combinations of techniques. This chapter would be an overview of these novel techniques with reference to latest clinical trials and meta-analyses.","PeriodicalId":211064,"journal":{"name":"Current Topics in Colorectal Surgery [Working Title]","volume":" 42","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2021-09-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"120943230","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2021-09-20DOI: 10.5772/intechopen.99120
Sanghyun An, I. Kim
Worldwide, colorectal cancer is the third most common cancer and one of the leading causes of cancer-related deaths. Currently, total mesorectal excision (TME) is considered as the gold standard surgical procedure for rectal cancer. To achieve a good oncologic outcome and functional outcome after TME in distal rectal cancer, exact knowledge regarding the pelvic anatomy including pelvic fascia, pelvic floor, and the autonomic nerve is essential. Accurate TME along the embryologic plane not only reduces local recurrence rate but also preserves urinary and sexual function by minimizing nerve damage. In the past, pelvic floor muscles and autonomic nerves could not be visualized clearly, however, the development of imaging studies and improvements of minimally invasive surgical techniques such as laparoscopic and robotic surgery can clearly show the anatomy of the pelvic region. In this chapter, we will provide accurate anatomy of the rectum and the anal canal, pelvic fascia, and the pelvic autonomic nerve. This anatomical information will be an important indicator for performing an adequate operation for distal rectal cancer.
{"title":"Pelvic Anatomy for Distal Rectal Cancer Surgery","authors":"Sanghyun An, I. Kim","doi":"10.5772/intechopen.99120","DOIUrl":"https://doi.org/10.5772/intechopen.99120","url":null,"abstract":"Worldwide, colorectal cancer is the third most common cancer and one of the leading causes of cancer-related deaths. Currently, total mesorectal excision (TME) is considered as the gold standard surgical procedure for rectal cancer. To achieve a good oncologic outcome and functional outcome after TME in distal rectal cancer, exact knowledge regarding the pelvic anatomy including pelvic fascia, pelvic floor, and the autonomic nerve is essential. Accurate TME along the embryologic plane not only reduces local recurrence rate but also preserves urinary and sexual function by minimizing nerve damage. In the past, pelvic floor muscles and autonomic nerves could not be visualized clearly, however, the development of imaging studies and improvements of minimally invasive surgical techniques such as laparoscopic and robotic surgery can clearly show the anatomy of the pelvic region. In this chapter, we will provide accurate anatomy of the rectum and the anal canal, pelvic fascia, and the pelvic autonomic nerve. This anatomical information will be an important indicator for performing an adequate operation for distal rectal cancer.","PeriodicalId":211064,"journal":{"name":"Current Topics in Colorectal Surgery [Working Title]","volume":"19 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2021-09-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"114927687","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2021-08-26DOI: 10.5772/intechopen.99560
C. Nicolescu, B. Suciu, A. Tudor, C. Russu, M. Gherghinescu, V. Butiurca, M. Botoncea, Cătălin Cosma, C. Molnar
This chapter deals with the emergency treatment of transverse colon cancer. The main complications that classify transverse colon cancer in an emergency setting are obstruction, perforation accompanied by localized or generalized peritonitis, and hemorrhage which may be occult or cataclysmic with hemorrhagic shock. We present the technical principles of radical surgical resection using embryological, anatomical, and oncological concepts. In this chapter we also discuss the principles of lymphadenectomy associated with complete excision of the mesocolon with high vascular ligation, in particular with T3 or T4 cancers requiring D2/D3 lymphadenectomy. The use of infrapyloric, gastro-epiploic, and prepancreatic lymphadenectomy is recommended due to the frequent metastases in these regional lymph nodes.
{"title":"Emergency Treatment of Transverse Colon Cancer","authors":"C. Nicolescu, B. Suciu, A. Tudor, C. Russu, M. Gherghinescu, V. Butiurca, M. Botoncea, Cătălin Cosma, C. Molnar","doi":"10.5772/intechopen.99560","DOIUrl":"https://doi.org/10.5772/intechopen.99560","url":null,"abstract":"This chapter deals with the emergency treatment of transverse colon cancer. The main complications that classify transverse colon cancer in an emergency setting are obstruction, perforation accompanied by localized or generalized peritonitis, and hemorrhage which may be occult or cataclysmic with hemorrhagic shock. We present the technical principles of radical surgical resection using embryological, anatomical, and oncological concepts. In this chapter we also discuss the principles of lymphadenectomy associated with complete excision of the mesocolon with high vascular ligation, in particular with T3 or T4 cancers requiring D2/D3 lymphadenectomy. The use of infrapyloric, gastro-epiploic, and prepancreatic lymphadenectomy is recommended due to the frequent metastases in these regional lymph nodes.","PeriodicalId":211064,"journal":{"name":"Current Topics in Colorectal Surgery [Working Title]","volume":"11 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2021-08-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"116906038","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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