Week 5.2 - Colorectal Surgery Flashcards
What is the most to least common site of CRC?
- 43% proximal colon
- 30% distal colon
- 27% rectum
colon and rectum respond differently to chemo
What do we perform surgery on?
- CRC
- Polyps
- Functional bowel problems
- Pelvic floor disease
- benign issues - fistulas, fissures, piles, peritoneal malignancies, anal cancers
What are types of surgery we carry out?
- open surgery
- endoscopic
- laparoscopic/robotics/NOTES
What are functions of the colon?
- water+electrolyte absorption
- production and absorption of vitamins K and B
- Storage of faeces
- hosts gut microbiota
What do we use to screen colorectal cancers and who do we screen?
- qFIT - quantitative faecal haemoglobin levels.
- 50-74
- range 0-200. 80+ is concern and we do colonoscopy to caecum
Why do we remove polyps?
- prophylatic purposes
- commonly involves in transition from normal epithelium to malignancy
- develop mutation which then can become severe dysplasia and eventually adenocarcinoma
How do we remove polyps?
- depends on size
- some hot snare polypectomy
- larger take longer
- when many, sometimes resort to colectomy
What symptoms do colorectal patients commonly complain of?
- abdominal pain
- bleeding
- change in bowel habits
- weight loss, fatigue, vomiting
What differentiates low risk from watch-and-wait patients?
- low risk under 40 and less than 6 weeks - typically haemorrhoids
- watch and wait 6 weeks and older - assess and review to see recurring symptoms. try colonoscopy or CT colon
How do you investigate a colon abnormality?
- colonoscopy with biopsies
- CT abdomen and pelvis with contrast
- do MRI if tumour in pelvis.
- PET for metastasis
- Stage with TNM
What do you often do pre-op for colon surgery?
- for colon, straight to surgery often
- for rectum, commonly chemo/RT neo-adjuvant if tumour threatens our ability to get full resection, determined by MRI.
What occurs during a rectal cancer surgery?
entire rectum removed, as well as mesorectum, lymph tisse and blood supply to the rectum - ensures R0 resection
What is an R0 vs R1 resection?
R0 - full resection of tumour
R1 - some tumour left
How do we ensure we get a R0 resection?
CT and (MRI for rectum) scanning to see if perforation of tumour. if present, do chemo/RT neo-adjuvant therapy to shrink first
What are different aims of treatment?
- resection
- restoring intestinal continuity via anastamoses
- stoma
- palliative
What does the decision to anastamose the colon depend on?
- good perfusion
- good oxygenation
- good blood pressure
- risk of anastamotic leak death
How do you carry out an anastamosis?
staple the small colon and large. then remove area of abnormality
What are types of stoma and surgeries that lead to them?
- ileostomy has spout usually due to liquidy loose stools, typically in right iliac fossa
- colostomy has no spout - usually solid stools and in left iliac fossa.
What are complications of anastamosis and stoma?
of anastamoses
- anastamotic leak
of stoma
- ischaemia
- retraction or prolapse of stoma
- hernia
- high output
What is post-op for bowel surgery?
- depends on lymph node or vascular invasion - may need adjuvant therapy. determine if patient is fit enough
- do CT chest abdomen and pelvis for 1st 3 years
What causes small bowel obstruction and large bowel obstruction?
small
- adhesions, hernias, tumours
large
- 60% malignant, rest benign - strictures, diverticular disease, ischaemia
What is bowel obstruction regarded as?
medical emergency. treat same day otherwise high risk of perforation
How do you manage a bowel obstruction?
- IV fluids, nasogastric tube, IV painkillers, IV antibiotics, unblock.
- then take bloods, blood gas for lactate, CT abdomen and pelvis
What does bowel ischaemia lead to?
agonising pain but no abdomen feeling
