Procedures

The most important point to remember is that everyone with a bowel problem can be helped and many can be completely cured.
Whenever possible, we offer procedures using minimally invasive techniques.

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Bowel Resections

Surgery is the only curative modality for localized colon and rectal cancer (stage I-III) and potentially provides the only curative option for patients with limited metastatic disease in liver and/or lung (stage IV disease).

Indications

For lesions in the cecum and right colon, a right hemicolectomy is indicated. Lesions in the proximal or middle transverse colon, are generally treated by an extended right hemicolectomy. For lesions in the splenic flexure and left colon, a left hemicolectomy is indicated. For sigmoid colon lesions, a sigmoid colectomy is appropriate. Total abdominal colectomy with ileo-rectal anastomosis may be required for patients with any of the following:

Hereditary nonpolyposis colon cancer syndrome (HNPCC)

Attenuated familial adenomatous polyposis (FAP)

Metachronous cancers in separate colon segments

Laparoscopy

The advent of laparoscopy has revolutionized the surgical approach to colonic resections for cancers. Large prospective randomized trials have found no significant differences between open and laparoscopic colectomy with regard to intraoperative or postoperative complications, perioperative mortality rates, readmission or reoperation rates, or rate of surgical wound recurrence. Oncologic outcomes (cause-specific survival, disease recurrence, number of lymph nodes harvested) are likewise comparable. However, laparoscopic surgery offers several advantages: earlier hospital discharge, return to work and normal activities, less post-operative pain, lower incidence of incisional hernias and post-operative adhesions and reduced rates of surgical site infections (SSI); the cosmetic appearances are also improved.

For rectal cancer, surgical options are:

Anterior resection. This involves removing all or part of the rectum and creating an anastomosis between the colon and lower rectum/anus. A permanent colostomy is thus avoided, but in most cases a temporary ileostomy is still required; in some cases, this is subsequently never reversed and becomes permanent.

Abdomino-perineal excision requires formation of a permanent colostomy and has other disadvantages:

Significantly higher short-term morbidity and mortalityineal excision requires formation of a permanent colostomy and has other disadvantages:

Significantly higher long-term morbidities

Higher rate of sexual and urinary dysfunction

Trans-anal resection avoids entering the abdominal cavity and the creation of a stoma, and is associated with a much faster post-operative recovery and fewer complications. Patient selection is very important and tumours have to meet certain criteria:

Lesions located in low rectum (within 8-10 cm)

Lesions occupying less than one third of the rectal circumference

Mobile exophitic or polypoid lesions

Lesions less than 3 cm in size

T1 lesions

Low grade tumor (well or moderately differentiated)

Negative nodal status (clinical and radiographic)

Robotic surgery

Robotic surgery has been proposed as being able to offer better dissection and access for rectal tumours; however, it has higher costs and there is as yet no hard evidence of its superiority over conventional laparoscopic surgery.

Initial reports point towards lower rates of conversion to an open procedure, better quality of resection with preservation of pelvic nerves essential for maintaining sexual and bladder function, and lower risk of margin involvement by tumour.