This lecture discusses the classification, staging, surgical treatment options, and management principles for colorectal carcinoma (CRC). It covers: 1) the various classification systems for CRC including Duke's, Astler-Coller, UICC, and AJCC; 2) preoperative staging and bowel preparation; 3) surgical resection procedures for different tumor locations from right hemicolectomy to abdominoperineal resection; 4) principles of total mesorectal excision for rectal carcinoma; and 5) the role of adjuvant chemotherapy and 5-year survival rates based on disease stage.
In this presentation, I have shown how to do open anterior resection both high and low varieties in a step-by-step manner with clear pictures as if reading an atlas of operative surgery.
Brief description of hepatectomy with indications, procedure, pre operative, intra operative and post operative management of the patient. Also describes the various techniques and instrument available for liver resection.
A multidisciplinary approach that includes surgery, medical oncology, and radiation oncology is required for optimal treatment of patients with rectal cancer
In Depth review of the Surgical management of esophageal carcinoma including management overview, endoscopic management, Type of surgeries, Open, and minimally invasive, Extent of lymphadenectomy. Literature review of evidence for type of surgery and complications
Minimal invasive Surgery in Management of colorectal cancerpiyushpatwa
Laparoscopic Anterior resection. After insertion of ports with patient in steep trendelenburg position Inferior mesenteric artery was identified and high ligation done with division of left colic artery and then medial to lateral dissection was done. Subsequently inferior mesenteric vein was dissected and clipped and divided. Distal dissection proceeded just behind the superior rectal artery and after identification and preservation of the hypogastric nerves, upper rectum was mobilised. Division of bowel was done at upper rectum after giving adequate distal margin and end to end anastomosis was done using circular stapler.
It is a complete presentation on carcinoma penis, covering all aspects starting from premalignant lesions to details of squamous cell carcinoma penis including recent NCCN guidelines and steps of penectomy and lymph node dissection
In this presentation, I have shown how to do open anterior resection both high and low varieties in a step-by-step manner with clear pictures as if reading an atlas of operative surgery.
Brief description of hepatectomy with indications, procedure, pre operative, intra operative and post operative management of the patient. Also describes the various techniques and instrument available for liver resection.
A multidisciplinary approach that includes surgery, medical oncology, and radiation oncology is required for optimal treatment of patients with rectal cancer
In Depth review of the Surgical management of esophageal carcinoma including management overview, endoscopic management, Type of surgeries, Open, and minimally invasive, Extent of lymphadenectomy. Literature review of evidence for type of surgery and complications
Minimal invasive Surgery in Management of colorectal cancerpiyushpatwa
Laparoscopic Anterior resection. After insertion of ports with patient in steep trendelenburg position Inferior mesenteric artery was identified and high ligation done with division of left colic artery and then medial to lateral dissection was done. Subsequently inferior mesenteric vein was dissected and clipped and divided. Distal dissection proceeded just behind the superior rectal artery and after identification and preservation of the hypogastric nerves, upper rectum was mobilised. Division of bowel was done at upper rectum after giving adequate distal margin and end to end anastomosis was done using circular stapler.
It is a complete presentation on carcinoma penis, covering all aspects starting from premalignant lesions to details of squamous cell carcinoma penis including recent NCCN guidelines and steps of penectomy and lymph node dissection
Surgical management of Carcinoma EsophagusLoveleen Garg
A detailed dicussion on surgical procedures & steps to be followed during surgery for Carcinoma esophagus.
Source- Schwartz's Principles of Surgery, 9th Edition
Anatomy of the stomach
Brief history of gastric surgery
Indications of Gastrectomy
The different types of gastrectomies.
The various reconstructions following a gastrectomy
Post Gastrectomy syndromes
The lecture describes the definition of sepsis, infection, basteremia and how it leads to spetic shock and a general managent guidelines - for King Edward Medical Unviversity, Lahore
CRISPR-Cas9, a revolutionary gene-editing tool, holds immense potential to reshape medicine, agriculture, and our understanding of life. But like any powerful tool, it comes with ethical considerations.
Unveiling CRISPR: This naturally occurring bacterial defense system (crRNA & Cas9 protein) fights viruses. Scientists repurposed it for precise gene editing (correction, deletion, insertion) by targeting specific DNA sequences.
The Promise: CRISPR offers exciting possibilities:
Gene Therapy: Correcting genetic diseases like cystic fibrosis.
Agriculture: Engineering crops resistant to pests and harsh environments.
Research: Studying gene function to unlock new knowledge.
The Peril: Ethical concerns demand attention:
Off-target Effects: Unintended DNA edits can have unforeseen consequences.
Eugenics: Misusing CRISPR for designer babies raises social and ethical questions.
Equity: High costs could limit access to this potentially life-saving technology.
The Path Forward: Responsible development is crucial:
International Collaboration: Clear guidelines are needed for research and human trials.
Public Education: Open discussions ensure informed decisions about CRISPR.
Prioritize Safety and Ethics: Safety and ethical principles must be paramount.
CRISPR offers a powerful tool for a better future, but responsible development and addressing ethical concerns are essential. By prioritizing safety, fostering open dialogue, and ensuring equitable access, we can harness CRISPR's power for the benefit of all. (2998 characters)
One of the most developed cities of India, the city of Chennai is the capital of Tamilnadu and many people from different parts of India come here to earn their bread and butter. Being a metropolitan, the city is filled with towering building and beaches but the sad part as with almost every Indian city
India Clinical Trials Market: Industry Size and Growth Trends [2030] Analyzed...Kumar Satyam
According to TechSci Research report, "India Clinical Trials Market- By Region, Competition, Forecast & Opportunities, 2030F," the India Clinical Trials Market was valued at USD 2.05 billion in 2024 and is projected to grow at a compound annual growth rate (CAGR) of 8.64% through 2030. The market is driven by a variety of factors, making India an attractive destination for pharmaceutical companies and researchers. India's vast and diverse patient population, cost-effective operational environment, and a large pool of skilled medical professionals contribute significantly to the market's growth. Additionally, increasing government support in streamlining regulations and the growing prevalence of lifestyle diseases further propel the clinical trials market.
Growing Prevalence of Lifestyle Diseases
The rising incidence of lifestyle diseases such as diabetes, cardiovascular diseases, and cancer is a major trend driving the clinical trials market in India. These conditions necessitate the development and testing of new treatment methods, creating a robust demand for clinical trials. The increasing burden of these diseases highlights the need for innovative therapies and underscores the importance of India as a key player in global clinical research.
Medical Technology Tackles New Health Care Demand - Research Report - March 2...pchutichetpong
M Capital Group (“MCG”) predicts that with, against, despite, and even without the global pandemic, the medical technology (MedTech) industry shows signs of continuous healthy growth, driven by smaller, faster, and cheaper devices, growing demand for home-based applications, technological innovation, strategic acquisitions, investments, and SPAC listings. MCG predicts that this should reflects itself in annual growth of over 6%, well beyond 2028.
According to Chris Mouchabhani, Managing Partner at M Capital Group, “Despite all economic scenarios that one may consider, beyond overall economic shocks, medical technology should remain one of the most promising and robust sectors over the short to medium term and well beyond 2028.”
There is a movement towards home-based care for the elderly, next generation scanning and MRI devices, wearable technology, artificial intelligence incorporation, and online connectivity. Experts also see a focus on predictive, preventive, personalized, participatory, and precision medicine, with rising levels of integration of home care and technological innovation.
The average cost of treatment has been rising across the board, creating additional financial burdens to governments, healthcare providers and insurance companies. According to MCG, cost-per-inpatient-stay in the United States alone rose on average annually by over 13% between 2014 to 2021, leading MedTech to focus research efforts on optimized medical equipment at lower price points, whilst emphasizing portability and ease of use. Namely, 46% of the 1,008 medical technology companies in the 2021 MedTech Innovator (“MTI”) database are focusing on prevention, wellness, detection, or diagnosis, signaling a clear push for preventive care to also tackle costs.
In addition, there has also been a lasting impact on consumer and medical demand for home care, supported by the pandemic. Lockdowns, closure of care facilities, and healthcare systems subjected to capacity pressure, accelerated demand away from traditional inpatient care. Now, outpatient care solutions are driving industry production, with nearly 70% of recent diagnostics start-up companies producing products in areas such as ambulatory clinics, at-home care, and self-administered diagnostics.
Defecation
Normal defecation begins with movement in the left colon, moving stool toward the anus. When stool reaches the rectum, the distention causes relaxation of the internal sphincter and an awareness of the need to defecate. At the time of defecation, the external sphincter relaxes, and abdominal muscles contract, increasing intrarectal pressure and forcing the stool out
The Valsalva maneuver exerts pressure to expel faeces through a voluntary contraction of the abdominal muscles while maintaining forced expiration against a closed airway. Patients with cardiovascular disease, glaucoma, increased intracranial pressure, or a new surgical wound are at greater risk for cardiac dysrhythmias and elevated blood pressure with the Valsalva maneuver and need to avoid straining to pass the stool.
Normal defecation is painless, resulting in passage of soft, formed stool
CONSTIPATION
Constipation is a symptom, not a disease. Improper diet, reduced fluid intake, lack of exercise, and certain medications can cause constipation. For example, patients receiving opiates for pain after surgery often require a stool softener or laxative to prevent constipation. The signs of constipation include infrequent bowel movements (less than every 3 days), difficulty passing stools, excessive straining, inability to defecate at will, and hard feaces
IMPACTION
Fecal impaction results from unrelieved constipation. It is a collection of hardened feces wedged in the rectum that a person cannot expel. In cases of severe impaction the mass extends up into the sigmoid colon.
DIARRHEA
Diarrhea is an increase in the number of stools and the passage of liquid, unformed feces. It is associated with disorders affecting digestion, absorption, and secretion in the GI tract. Intestinal contents pass through the small and large intestine too quickly to allow for the usual absorption of fluid and nutrients. Irritation within the colon results in increased mucus secretion. As a result, feces become watery, and the patient is unable to control the urge to defecate. Normally an anal bag is safe and effective in long-term treatment of patients with fecal incontinence at home, in hospice, or in the hospital. Fecal incontinence is expensive and a potentially dangerous condition in terms of contamination and risk of skin ulceration
HEMORRHOIDS
Hemorrhoids are dilated, engorged veins in the lining of the rectum. They are either external or internal.
FLATULENCE
As gas accumulates in the lumen of the intestines, the bowel wall stretches and distends (flatulence). It is a common cause of abdominal fullness, pain, and cramping. Normally intestinal gas escapes through the mouth (belching) or the anus (passing of flatus)
FECAL INCONTINENCE
Fecal incontinence is the inability to control passage of feces and gas from the anus. Incontinence harms a patient’s body image
PREPARATION AND GIVING OF LAXATIVESACCORDING TO POTTER AND PERRY,
An enema is the instillation of a solution into the rectum and sig
Global launch of the Healthy Ageing and Prevention Index 2nd wave – alongside...ILC- UK
The Healthy Ageing and Prevention Index is an online tool created by ILC that ranks countries on six metrics including, life span, health span, work span, income, environmental performance, and happiness. The Index helps us understand how well countries have adapted to longevity and inform decision makers on what must be done to maximise the economic benefits that comes with living well for longer.
Alongside the 77th World Health Assembly in Geneva on 28 May 2024, we launched the second version of our Index, allowing us to track progress and give new insights into what needs to be done to keep populations healthier for longer.
The speakers included:
Professor Orazio Schillaci, Minister of Health, Italy
Dr Hans Groth, Chairman of the Board, World Demographic & Ageing Forum
Professor Ilona Kickbusch, Founder and Chair, Global Health Centre, Geneva Graduate Institute and co-chair, World Health Summit Council
Dr Natasha Azzopardi Muscat, Director, Country Health Policies and Systems Division, World Health Organisation EURO
Dr Marta Lomazzi, Executive Manager, World Federation of Public Health Associations
Dr Shyam Bishen, Head, Centre for Health and Healthcare and Member of the Executive Committee, World Economic Forum
Dr Karin Tegmark Wisell, Director General, Public Health Agency of Sweden
How many patients does case series should have In comparison to case reports.pdfpubrica101
Pubrica’s team of researchers and writers create scientific and medical research articles, which may be important resources for authors and practitioners. Pubrica medical writers assist you in creating and revising the introduction by alerting the reader to gaps in the chosen study subject. Our professionals understand the order in which the hypothesis topic is followed by the broad subject, the issue, and the backdrop.
https://pubrica.com/academy/case-study-or-series/how-many-patients-does-case-series-should-have-in-comparison-to-case-reports/
R3 Stem Cells and Kidney Repair A New Horizon in Nephrology.pptxR3 Stem Cell
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Navigating Challenges: Mental Health, Legislation, and the Prison System in B...Guillermo Rivera
This conference will delve into the intricate intersections between mental health, legal frameworks, and the prison system in Bolivia. It aims to provide a comprehensive overview of the current challenges faced by mental health professionals working within the legislative and correctional landscapes. Topics of discussion will include the prevalence and impact of mental health issues among the incarcerated population, the effectiveness of existing mental health policies and legislation, and potential reforms to enhance the mental health support system within prisons.
Navigating Challenges: Mental Health, Legislation, and the Prison System in B...
Carcinoma rectum & colon part 2
1. Prof. Khalid Masud Gondal
FCPS(Pak),FICS(USA),FCPS(BD),DCPS(HPE)
Professor of surgery KEMU
Councilor & Regional Director CPSP Lahore
Carcinoma Rectum & Colon
Lecture II
2. THIS LECTURE IS
ABOUT
• Classification of Colorectal Carcinomas
• How to Prepare a patient for surgery with CRC?
• Oncologic Principles Of Surgery
• Siting of Stomas
• Surgical options for CRC
• Stage specific treatment
3. Various Classification
Systems for CRC
• The carcinoma colon is classified
according to
o Duke’s Classification
o Modified Asler Coller
o UICC Classification
o AJCC Classification
5. AJCC Classification of Colorectal Carcinoma
Tis:
Carcinoma
in Situ
Or
Invasion of
lamina
propria
N=0
M=0
N=0
M=0
Tany
Nany
M1
Metasta
sis
6. Management Plan
o Preoperative staging
o Assess operability
o Synchronous tumors exclusion
o Stoma issues
o Aim: removal of primary tumor and its draining loco
regional lymph nodes
o Histological grading for adjuvant therapy
11. Mechanical bowel preparation:
• Prograde washout using nasogastric tube with saline
• If patient presents with obstruction, then consider on
table lavage
12. Management Principles
• Any surgical resection requires 5 cm proximal
and 2 cm distal clearance for colonic lesions
• 1 cm distal clearance of rectal lesions adequate if
mesorectum resected
• Lymph node resection performed to the origin of
the feeding vessel
• En Bloc resection of adherent tumours should be
performed
13. Operability:
• Liver palpated for secondary deposits
• Peritoneum especially pelvic peritoneum and
omentum inspected for tumour seedlings
• Various draining lymph node groups palpated for
enlargement
• Tumour examined for mobility/fixity and operability
14. Counseling and siting of stoma:
• Counseling and siting of stoma:
• Take consent regarding permanent colostomy
• Counseling with stoma nurse
• Explain the care of stoma
15. Counseling and siting of stoma:
• Correct Siting of stoma
o In a triangle between
ASIS, umbilicus and
lateral border of rectus
sheath
o Should be through the
rectus muscle
17. Right hemi colectomy
• Carcinoma of cecum or
right colon
• Ileocolic vessels, right colic
vessels and right branches of
middle colic vessels ligated and
divided
• Ileal- transverse colic
anastomosis
18. Extended right Hemicolectomy:
o For lesions of hepatic flexure
or proximal transverse colon
o Right colon and proximal 2/3rd
transverse colon resected
o Ileocolic, right colic and right and
left branches of middle colic ligated
and divided
o Distal ileal-distal transverse colon
anastomosis
19. Transverse colectomy:
• Lesions in mid-
transverse colon
• Middle colic vessels ligated
and divided
• A transverse colocolic
anastomosis
20. Left hemicolectomy
• Tumours confined to splenic
flexure or descending
colon
• Left branches of middle colic,
left colic vessels, first brances
of sigmoid vessels ligated and
divided
• Colocolic anastomosis
21. Extended Left hemicolectomy
• Tumours in distal
transverse colon
• Left colectomy is extended
proximally to include right
branch of middle colic
artery
• Colocolic anastomosis
22. Sigmoid colectomy
o Tumours of sigmoid colon
o Ligation and division of sigmoid
brances of inferior mesenteric
artery
o Anastomosis between descending
colon and rectum
23. Synchronous tumors
Management
oTotal colectomy:
• Ileocolic, right colic, middle colic, left colic and
sigmoid vessles ligated and divided.
• Superior rectal vessels preserved
• Anastomosis between ileum and upper rectum
o Subtotal colectomy:
• Sigmoid vessels preserved
• Anastomosis between ileum
and sigmoid colon
24. I II III IV
• No risk of lymph node metastasis
• Complete excision of polyp with tumour free margins.
• If complete excision not possible; consider segmental
resection
25. • Segmental colectomy is advised especially if
• Lympho-vascular invasion
• Poorly differentiated
• Tumor within 1 mm resection margin
I II III IV
26. I II III IV
• Surgical resection
• Adjuvant Chemotherapy– controversial role
27. I II III IV
• Lymph node metastasis T any, N1, M0
• Surgical resection
• Adjuvant chemotherapy must be given
o5-Flourouracil based regimens
28. • Selected patients with isolated resectable metastasis---- consider
metastatectomy
• Two stage procedure or combined with resection of primary tumour
• Consider use of palliative treatment:
• Colonic stenting
• Diversion colostomy
• Definitive chemotherapy treatment in all advanced cases
I II III IV
31. Principles of management
• Rectal Carcinoma:
o Radical excision of the rectum, with mesorectum and
associated lymph nodes should be the aim
o Restore gastrointestinal continuity whenever possible
o Preserve continence by saving sphincter whenever
possible
32. • Holy plane of Heald: Between mesorectum and sacrum
• The fascial envelope
o Posteriorly Waldeyer s Fascia: Between rectum and sacrum
o Anteriorly: Denonvilliers Fascia
o Lateral Ligaments with middle rectal vessels
Management -Rectal Carcinoma:
33. Rectal Carcinoma
• AIM
o Resection of the tumour
• Low/ Anterior resection
• Abdominoperineal resection
• Pelvic Sweep
o Total mesorectal excision
35. Rectal Carcinoma:
Anterior Resection
o High proximal ligation of inferior
mesenteric vessels
o Rectum mobilized and
removed
o End to end anastomosis
• Manual or stapling
o Protecting stoma may be required
37. Abdomino-perineal
resction:
o Abdominal procedure:
• Pelvic colon mobilized
• Pelvic peritoneum divided
• Inferior mesenteric artery divided and ligated
• Rectosigmoid mesentry divided
• Hypogastric plexus saved by dissecting in the Holy plane
• Lateral ligaments with middle rectal vessels divided after
ligation
38. Abdomino-perineal
resction
o Preineal approach:
• Elliptical incision around anus
• Levator ani divided laterally
• Waldeyer s Fascia incised n divided
• Rectum mobilized from all sides
• Rectum and anus removed per rectally
• End colostomy made
• Perineal wound closedaround drain
40. Rectal Carcinoma
o Pelvic exentration:
o Removal of all pelvic
organs
o Alongwith internal iliac and
obturator group of lymph
nodes
o Both internal iliac vessels
ligated and divided
o Urinary diversion with ileal
conduit is required
41.
42. Adjuvant Chemotherapy
for CRC
• All patients with Stage III
• Patients with Stage II (High risk)
o Number of lymph nodes involved
o T4 lesions
o Perforation
o Peritumour Lymph vascular involvement
o Poorly differentiated histology
o Assessment of anticipated life expectancy
44. Follow up and Surveillance:
o Colonic cancer:
• Colonoscpy 12 months after the diagnosis
• Repeated every 3 to 5 years
o Rectal carcinoma:
• Most recurrences occur within 2 years
• Patient followed for at least 2 years
• CEA every 2-3 months for 2 years
• Endorectal ultrasounds
45. Further advances
• Role of
o Radio-immunoguided surgery
o Targeted chemotherapy
In management of colorectal malignancy