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GIHEP Surgery - CRC (ii) Tx (palliative (for unresectable mets/tumours,…
GIHEP Surgery - CRC (ii) Tx
Potentially curative
surgery
colonic resections
right hemicolectomy
take appendix, caecum, ascending colon, right 2/3 transverse colon
left hemicolectomy
take left 1/3 transverse colon, descending colon, sigmoid colon
rectal tumour resections
upper 1/3: Ant resection
leave anus intact
primary anastomosis + temporary ileostomy
continuity can be resorted again with another surgery (risk of leakage) - wait @ least 6 wks +patient has finished chemo
need 2cm clear margin
middle + lower 1/3: APR (abdomino-perineal resection)
for low tumours involving anal sphincter (<5cm from anal verge)
no anal opening
permanent end colostomy
depending on stage of local development, possibly neoadjuvant (pre-op) chemoradiotherapy (reduced local recurrence)
appropriate margins of resection
proximal margins @ least >5cm (dictated by blood supply)
distal margins in upper + middle 1/3 - aim for 5cm
adjuvant chemo (post-op) offered for tumours with +ve nodes or evidence of vasc invasion
others
to restore function/capacity to store stool after removed rectum
Colonic J Pouch (surgically creating a J-shaped reservoir out of SI)
coloplasty
TME (total mesolectal excision)
gold standard
significant length of bowel round tumour also removed
high ligation of pedicle vessels (blood supply)
palliative
for unresectable mets/tumours
chemo
endoluminal stents
transanal ablation of rectal obstructing tumours (uncommon)
surgery for untenable obstruction, bleeding, or severe symptoms