Cylindrical APR
•Download as PPTX, PDF•
3 likes•4,419 views
Cylindrical abdominoperineal resection (APR) provides improved oncologic outcomes for low rectal cancer compared to standard APR. It involves a more extensive dissection in the pelvis during the abdominal phase and an extended perineal resection. This removes more tissue outside the muscularis propria of the rectum, reducing circumferential resection margin involvement and local recurrence rates. However, it may increase risks of perineal wound complications. Tips for the procedure include amputating a fatty sigmoid colon, taking care when reflecting an anteriorly attached tumor, placing an omental pedicle in the pelvis, and remembering to place a drain.
Report
Share
Report
Share
Recommended
Rectal carcinoma approach
The document discusses recent advances in the management of rectal cancer. It covers:
1. Molecular biology advances like DNA chip technology that help determine prognosis and need for prophylactic surgery based on genes like APC, mismatch repair genes, and markers like p21 and p53.
2. Improved staging using endorectal ultrasound, CT, MRI and PET scans to accurately determine tumor depth and node involvement to guide treatment decisions.
3. Advances in surgery including total mesorectal excision, laparoscopic and robotic techniques, and the use of neoadjuvant chemoradiation to improve outcomes.
Locoregional therapy for HCC
This document discusses locoregional therapies for hepatocellular carcinoma (HCC), specifically percutaneous ethanol injection (PEI) and radiofrequency ablation (RFA). It provides details on the procedures, indications, outcomes, and complications of PEI and RFA. PEI involves injecting ethanol directly into tumors to induce chemical necrosis. It is indicated for HCC lesions ≤3 cm and can achieve complete ablation in 70-80% of lesions <3 cm. RFA uses heat generated by radiofrequency energy to ablate tumors. It is effective for tumors <3 cm, with an ablation success rate of 90% for lesions <2 cm. Both PEI and RFA have low risks of major complications but can
Carcinoma esophagus 2020
This document provides an overview of carcinoma of the esophagus. It discusses the epidemiology, etiology, pathological classification, clinical features, staging, diagnosis and management of esophageal cancer. Esophageal cancer is the 8th most common cancer worldwide and has a poor 5-year survival rate of less than 18%. Risk factors and types of esophageal cancer vary globally. The document outlines the various diagnostic tests and staging systems used to evaluate esophageal cancer as well as endoscopic, surgical and non-surgical treatment options.
Ultrasound elastography of breast and prostate lesions
Ultrasound elastography is a technique that maps relative tissue stiffness. It has applications in evaluating breast and prostate lesions. Breast and prostate cancers are generally stiffer than normal tissues, appearing darker on elastograms. Ultrasound elastography can help differentiate benign from malignant lesions and improve biopsy and therapy guidance for conditions like breast fibroadenomas, cysts, invasive ductal carcinoma, and prostate cancer. It has sensitivities over 68% and specificities over 72% for detecting cancers and abnormalities.
Staging and Diagnostic approach of rectal cancer
MRI is useful for staging rectal cancer and assessing tumor involvement of surrounding structures. It can determine the depth of tumor invasion beyond the muscularis propria (T stage), evaluate the circumferential resection margin (CRM) distance between the tumor and mesorectal fascia, and identify suspicious lymph nodes. A tumor-mesorectal fascia distance of less than 1mm on MRI indicates a positive CRM, which is associated with higher rates of local recurrence. MRI is also used to assess nodal metastases based on node size, borders, and signal intensity. Accurate pre-treatment staging with MRI allows for optimal surgical planning and identification of patients who may benefit from neoadjuvant chemoradiation.
Management of Rectal Carcinoma
Preoperative chemoradiotherapy is commonly used to treat rectal cancer. It can reduce the tumor size and increase the likelihood of sphincter-sparing surgery. Studies have shown that preoperative chemoradiotherapy results in lower local recurrence rates compared to postoperative chemoradiotherapy or radiotherapy alone, without increasing distant metastases or mortality. Short-course radiotherapy followed by surgery within a week is also effective at reducing local recurrence compared to surgery alone, especially when combined with total mesorectal excision.
Diagnosis and treatment of pancreatic cancer
A review of methods of diagnosis and treatment of adenocarcinoma of the pancreas, with a focus on tumors of the head of the pancreas.
Primary GIT Lymphoma
The document discusses primary gastrointestinal lymphomas. It notes that the gastrointestinal tract is the most common site of extra nodal lymphoma, mostly non-Hodgkin lymphomas. The stomach is the most common site of involvement, accounting for 80% of cases, followed by the small intestine (15%) and colorectum (5%). Risk factors include H. pylori infection, autoimmune diseases, immunodeficiency, celiac disease, and inflammatory bowel disease. Diagnosis is typically made through endoscopy and biopsy. Presentation and histologic subtypes vary depending on the specific gastrointestinal location.
Recommended
Rectal carcinoma approach
The document discusses recent advances in the management of rectal cancer. It covers:
1. Molecular biology advances like DNA chip technology that help determine prognosis and need for prophylactic surgery based on genes like APC, mismatch repair genes, and markers like p21 and p53.
2. Improved staging using endorectal ultrasound, CT, MRI and PET scans to accurately determine tumor depth and node involvement to guide treatment decisions.
3. Advances in surgery including total mesorectal excision, laparoscopic and robotic techniques, and the use of neoadjuvant chemoradiation to improve outcomes.
Locoregional therapy for HCC
This document discusses locoregional therapies for hepatocellular carcinoma (HCC), specifically percutaneous ethanol injection (PEI) and radiofrequency ablation (RFA). It provides details on the procedures, indications, outcomes, and complications of PEI and RFA. PEI involves injecting ethanol directly into tumors to induce chemical necrosis. It is indicated for HCC lesions ≤3 cm and can achieve complete ablation in 70-80% of lesions <3 cm. RFA uses heat generated by radiofrequency energy to ablate tumors. It is effective for tumors <3 cm, with an ablation success rate of 90% for lesions <2 cm. Both PEI and RFA have low risks of major complications but can
Carcinoma esophagus 2020
This document provides an overview of carcinoma of the esophagus. It discusses the epidemiology, etiology, pathological classification, clinical features, staging, diagnosis and management of esophageal cancer. Esophageal cancer is the 8th most common cancer worldwide and has a poor 5-year survival rate of less than 18%. Risk factors and types of esophageal cancer vary globally. The document outlines the various diagnostic tests and staging systems used to evaluate esophageal cancer as well as endoscopic, surgical and non-surgical treatment options.
Ultrasound elastography of breast and prostate lesions
Ultrasound elastography is a technique that maps relative tissue stiffness. It has applications in evaluating breast and prostate lesions. Breast and prostate cancers are generally stiffer than normal tissues, appearing darker on elastograms. Ultrasound elastography can help differentiate benign from malignant lesions and improve biopsy and therapy guidance for conditions like breast fibroadenomas, cysts, invasive ductal carcinoma, and prostate cancer. It has sensitivities over 68% and specificities over 72% for detecting cancers and abnormalities.
Staging and Diagnostic approach of rectal cancer
MRI is useful for staging rectal cancer and assessing tumor involvement of surrounding structures. It can determine the depth of tumor invasion beyond the muscularis propria (T stage), evaluate the circumferential resection margin (CRM) distance between the tumor and mesorectal fascia, and identify suspicious lymph nodes. A tumor-mesorectal fascia distance of less than 1mm on MRI indicates a positive CRM, which is associated with higher rates of local recurrence. MRI is also used to assess nodal metastases based on node size, borders, and signal intensity. Accurate pre-treatment staging with MRI allows for optimal surgical planning and identification of patients who may benefit from neoadjuvant chemoradiation.
Management of Rectal Carcinoma
Preoperative chemoradiotherapy is commonly used to treat rectal cancer. It can reduce the tumor size and increase the likelihood of sphincter-sparing surgery. Studies have shown that preoperative chemoradiotherapy results in lower local recurrence rates compared to postoperative chemoradiotherapy or radiotherapy alone, without increasing distant metastases or mortality. Short-course radiotherapy followed by surgery within a week is also effective at reducing local recurrence compared to surgery alone, especially when combined with total mesorectal excision.
Diagnosis and treatment of pancreatic cancer
A review of methods of diagnosis and treatment of adenocarcinoma of the pancreas, with a focus on tumors of the head of the pancreas.
Primary GIT Lymphoma
The document discusses primary gastrointestinal lymphomas. It notes that the gastrointestinal tract is the most common site of extra nodal lymphoma, mostly non-Hodgkin lymphomas. The stomach is the most common site of involvement, accounting for 80% of cases, followed by the small intestine (15%) and colorectum (5%). Risk factors include H. pylori infection, autoimmune diseases, immunodeficiency, celiac disease, and inflammatory bowel disease. Diagnosis is typically made through endoscopy and biopsy. Presentation and histologic subtypes vary depending on the specific gastrointestinal location.
Single Incision Laparoscopic Surgery
Advantages of Single Incision Laparoscopic Surgery. medical Breakthroughs via Minimally Invasive surgery
Laparoscopic Ventral Hernia Repair
Laparoscopic ventral hernia repair involves placing mesh over the hernia defect using laparoscopic techniques. It has advantages over open repair such as lower wound complications, recurrence rates, hospital stay and pain. While more technically challenging, it is effective for primary and recurrent hernias. Outcomes are better in non-obese patients, with obese patients having higher recurrence rates and longer operating times.
Git Endoscopic Ultrasound.
EUS can be used to stage cancers of the esophagus, stomach, rectum, lung and diagnose pancreatic cancer. It allows evaluation of abnormalities in the GI tract wall and adjacent structures. EUS guided FNA biopsy enables cytopathological diagnosis of cancers and nodal metastases. EUS is well-suited for TNM tumor staging as it can assess depth of tumor penetration, locoregional nodal spread and vascular invasion. It also has applications in diagnosis of cholangiocarcinoma, evaluation of pancreatic cysts and masses, and celiac plexus neurolysis for pain relief.
Neoadjuvant therapy for esophageal cancer
Neoadjuvant therapy, including chemotherapy and chemoradiotherapy, is being investigated for the treatment of esophageal cancer. While some studies have shown improved survival rates with neoadjuvant therapy compared to surgery alone, the evidence from clinical trials remains conflicting. Achieving a complete pathological response after neoadjuvant therapy is associated with significantly improved long-term survival. Further research is still needed to determine the optimal neoadjuvant approaches and to improve outcomes by reducing distant metastases.
Retroperitoneal Collections
This document summarizes retroperitoneal anatomy, collections, and hematomas. It describes the three retroperitoneal compartments and expansive interfascial planes that allow collections to spread. Common causes of retroperitoneal hematomas are discussed. Diagnostic imaging includes CT or angiography. Management depends on stability and source of bleeding, ranging from conservative treatment to angiographic embolization or surgery.
Carcinoma rectum the complete aproach to how to investigate and treat a case ...
this is a complete guide to the understanding of the anatomy clinical features and the latest investigation to the most modern methods of treating the case of carcinoma rectum , all the latest journal published and the ongoing trials hav been searched and incorporated
Presentation1.pptx, radiological imaging of mesenteric ischemia.
1) Mesenteric ischemia has a high mortality rate of 30-90% due to nonspecific symptoms, benign physical exams, and delays in diagnosis.
2) Acute mesenteric ischemia is commonly caused by embolism or thrombosis while chronic ischemia is usually caused by atherosclerosis.
3) CT angiography is now recommended as the first imaging approach for acute mesenteric ischemia due to its ability to detect vascular abnormalities and bowel changes with high sensitivity and specificity. Angiography remains the gold standard for diagnosis and preoperative planning.
Esophaegeal resection & reconstruction
This document discusses esophageal resection and reconstruction techniques. It covers indications for resection such as carcinoma or injury. Common reconstruction conduits are the stomach, colon, jejunum or combinations. Reconstruction routes include posterior mediastinal, substernal or subcutaneous. Complications can include fistula, stricture or dysfunction. The goal is a viable patient with functional gastrointestinal continuity. Successful reconstruction lasts long, provides nutrition and is done safely with flexibility and a team approach.
TACE eligibity.pptx
TACE Eligibility and Proper Patient Selection
Transarterial chemoembolization eligibility and proper patient selection
Management of Giant Scrotal Hernia
1. The document discusses the surgical management and techniques for repairing giant inguino-scrotal hernias using laparoscopic total extraperitoneal (TEP) or transabdominal preperitoneal (TAPP) approaches.
2. Key steps for both TEP and TAPP are identified, including dissection to access the preperitoneal space, division of vessels and fascia to improve visibility and access, manual reduction of the hernia sac, and closure with mesh placement.
3. Outcomes data is presented showing low morbidity, reoperation and recurrence rates for both TEP and TAPP approaches for giant hernia repair. TAPP may be preferable for giant hernias due to easier
Peritoneal surface malignancies
1. Cytoreductive surgery (CRS) followed by intraperitoneal chemotherapy, either intraoperatively (HIPEC) or postoperatively, is the standard treatment for peritoneal surface malignancies like carcinomatosis and mesothelioma.
2. The extent of disease is measured by the peritoneal cancer index (PCI) and the completeness of cytoreduction (CC score), which help determine prognosis and likelihood of benefit from CRS and HIPEC.
3. Multiple clinical studies have shown median survival benefits of 2-4 times longer compared to systemic chemotherapy alone for conditions treated with CRS and HIPEC.
Surgery of Rectal Cancer : Potentials and Limitations - Dimitris P. Korkolis
EPIDEMOLOGY
2015 Estimates
New cases: 96,830 (colon); 40,000 (rectal)
Deaths: 50,310 (colon and rectal combined)
Death rate over last 20 years declining
Screening and improvements in treatment
Anal Cancer
This document summarizes information about anal cancer, including epidemiology, risk factors, staging, histology, and treatment approaches. It notes that anal cancer accounts for about 2% of gastrointestinal cancers. Risk factors include HPV, HIV/AIDS, and receptive anal intercourse. Treatment typically involves chemoradiation with 5-FU and mitomycin C, which results in high response rates. Additional trials have explored optimal radiation doses and chemotherapy regimens.
Reproteritoneum Anatomy and Pathology
The retroperitoneum lies between the posterior parietal peritoneum and anterior transversalis fascia. It is divided into three spaces by fasciae: anterior pararenal, perirenal, and posterior pararenal. Retroperitoneal organs include the duodenum, pancreas, kidneys, ureters, and great vessels. Fluid collections can extend between these spaces along interfascial planes. Characterization of retroperitoneal tumors involves identifying the organ of origin and patterns of spread. Specific radiologic signs like the "beak sign" can help determine the originating organ. The presence or absence of fat or other tissue components also provides clues to diagnosis.
Extralevator abdominoperineal resection(elape)
This document discusses the history and technique of the extended abdominoperineal excision (ELAPE) surgery for rectal cancer. It begins with Miles' description of the standard abdominoperineal resection (APR) in 1908. The ELAPE technique was developed to address high circumferential resection margin positivity and local recurrence rates with APR for low rectal cancers. The ELAPE surgery extends the abdominal phase of resection using total mesorectal excision principles and removes the levator muscles en bloc during the perineal phase. Initial studies show ELAPE reduces bowel perforation and positive margin rates compared to APR, with potentially lower local recurrence. However, large randomized controlled trials are still needed to establish EL
Soft tissue sarcoma (Retroperitoneal Sarcoma)
This document discusses retroperitoneal soft tissue sarcoma (RPS), including its most common histologies, clinical presentation, evaluation, treatment with surgery, radiotherapy, chemotherapy, targeted therapy, and management of recurrent disease. It provides details on surgical approaches for RPS including the importance of obtaining clear margins. It also reviews evidence on multimodality treatments including preoperative chemoradiation. Recurrence after initial treatment is high, but salvage surgery may provide a survival benefit in select patients depending on factors like tumor size and disease-free interval.
D2 gastrectomy
Laparoscopic radical gastrectomy for gastric cancer management is feasible in highly complex centers with advanced laparoscopic service with comparable oncological results to open procedures with free margins, adequate lymph node count, with a low complication rate and very low recurrence rate.
Ca rectum Management seminar 2019
seminar on ca rectum management including evolution of trials
Dr. kavita sehrawat
2019
MAMC ,DELHI
Peritoneal Carcinomatosis : Dr Amit Dangi
Here are the key steps:
1. The left subphrenic space is entered by incising the peritoneum overlying the left hemidiaphragm.
2. The peritoneum is dissected off the left hemidiaphragm in a cephalad direction towards the diaphragmatic crus.
3. The peritoneum is then stripped down the left paracolic gutter towards the pelvis, removing all peritoneal surfaces.
4. The left subphrenic peritonectomy is then completed, exposing the left hemidiaphragm and removing all peritoneal surfaces in the left subphrenic space.
Neoadjuvant therapy in colorectal carcinoma
- Several studies have shown that neoadjuvant therapy decreases local recurrence rates in colorectal cancer when compared to surgery alone. One study showed a statistically significant decrease in local recurrence with the addition of chemotherapy to preoperative radiotherapy.
- Evidence indicates that long-course chemoradiotherapy, induction chemotherapy followed by long-course chemoradiotherapy, and short-course radiotherapy are the three accepted neoadjuvant approaches, with long-course chemoradiotherapy being the most commonly used currently. Short-course radiotherapy has also shown non-inferior oncologic outcomes compared to long-course chemoradiotherapy in some studies.
MCC 2011 - Slide 9
The document discusses different techniques for performing an abdominoperineal resection (APR) for rectal cancer. It outlines problems with the conventional synchronous APR approach and proposes changing to standardized inter-sphincteric, extra-levator, or ischio-anal APR depending on tumor location. Each technique is defined by its relationship to anatomical structures. Indications, advantages, and positioning considerations are provided for each type of APR.
Laparoscopy in obesity Dr.Nutan Jain India
This document discusses obesity and minimally invasive surgery in gynecological procedures. It provides definitions of obesity, assessments for obese patients undergoing surgery, and techniques for laparoscopic surgery in obese patients. Key points include the use of longer instruments, perpendicular trocar insertion, and positioning to accommodate excess tissue. Minimally invasive surgery is shown to be as safe for obese patients as non-obese with proper precautions. It can significantly reduce morbidity compared to open surgery for procedures like hysterectomy and lymph node dissection in endometrial cancer.
More Related Content
What's hot
Single Incision Laparoscopic Surgery
Advantages of Single Incision Laparoscopic Surgery. medical Breakthroughs via Minimally Invasive surgery
Laparoscopic Ventral Hernia Repair
Laparoscopic ventral hernia repair involves placing mesh over the hernia defect using laparoscopic techniques. It has advantages over open repair such as lower wound complications, recurrence rates, hospital stay and pain. While more technically challenging, it is effective for primary and recurrent hernias. Outcomes are better in non-obese patients, with obese patients having higher recurrence rates and longer operating times.
Git Endoscopic Ultrasound.
EUS can be used to stage cancers of the esophagus, stomach, rectum, lung and diagnose pancreatic cancer. It allows evaluation of abnormalities in the GI tract wall and adjacent structures. EUS guided FNA biopsy enables cytopathological diagnosis of cancers and nodal metastases. EUS is well-suited for TNM tumor staging as it can assess depth of tumor penetration, locoregional nodal spread and vascular invasion. It also has applications in diagnosis of cholangiocarcinoma, evaluation of pancreatic cysts and masses, and celiac plexus neurolysis for pain relief.
Neoadjuvant therapy for esophageal cancer
Neoadjuvant therapy, including chemotherapy and chemoradiotherapy, is being investigated for the treatment of esophageal cancer. While some studies have shown improved survival rates with neoadjuvant therapy compared to surgery alone, the evidence from clinical trials remains conflicting. Achieving a complete pathological response after neoadjuvant therapy is associated with significantly improved long-term survival. Further research is still needed to determine the optimal neoadjuvant approaches and to improve outcomes by reducing distant metastases.
Retroperitoneal Collections
This document summarizes retroperitoneal anatomy, collections, and hematomas. It describes the three retroperitoneal compartments and expansive interfascial planes that allow collections to spread. Common causes of retroperitoneal hematomas are discussed. Diagnostic imaging includes CT or angiography. Management depends on stability and source of bleeding, ranging from conservative treatment to angiographic embolization or surgery.
Carcinoma rectum the complete aproach to how to investigate and treat a case ...
this is a complete guide to the understanding of the anatomy clinical features and the latest investigation to the most modern methods of treating the case of carcinoma rectum , all the latest journal published and the ongoing trials hav been searched and incorporated
Presentation1.pptx, radiological imaging of mesenteric ischemia.
1) Mesenteric ischemia has a high mortality rate of 30-90% due to nonspecific symptoms, benign physical exams, and delays in diagnosis.
2) Acute mesenteric ischemia is commonly caused by embolism or thrombosis while chronic ischemia is usually caused by atherosclerosis.
3) CT angiography is now recommended as the first imaging approach for acute mesenteric ischemia due to its ability to detect vascular abnormalities and bowel changes with high sensitivity and specificity. Angiography remains the gold standard for diagnosis and preoperative planning.
Esophaegeal resection & reconstruction
This document discusses esophageal resection and reconstruction techniques. It covers indications for resection such as carcinoma or injury. Common reconstruction conduits are the stomach, colon, jejunum or combinations. Reconstruction routes include posterior mediastinal, substernal or subcutaneous. Complications can include fistula, stricture or dysfunction. The goal is a viable patient with functional gastrointestinal continuity. Successful reconstruction lasts long, provides nutrition and is done safely with flexibility and a team approach.
TACE eligibity.pptx
TACE Eligibility and Proper Patient Selection
Transarterial chemoembolization eligibility and proper patient selection
Management of Giant Scrotal Hernia
1. The document discusses the surgical management and techniques for repairing giant inguino-scrotal hernias using laparoscopic total extraperitoneal (TEP) or transabdominal preperitoneal (TAPP) approaches.
2. Key steps for both TEP and TAPP are identified, including dissection to access the preperitoneal space, division of vessels and fascia to improve visibility and access, manual reduction of the hernia sac, and closure with mesh placement.
3. Outcomes data is presented showing low morbidity, reoperation and recurrence rates for both TEP and TAPP approaches for giant hernia repair. TAPP may be preferable for giant hernias due to easier
Peritoneal surface malignancies
1. Cytoreductive surgery (CRS) followed by intraperitoneal chemotherapy, either intraoperatively (HIPEC) or postoperatively, is the standard treatment for peritoneal surface malignancies like carcinomatosis and mesothelioma.
2. The extent of disease is measured by the peritoneal cancer index (PCI) and the completeness of cytoreduction (CC score), which help determine prognosis and likelihood of benefit from CRS and HIPEC.
3. Multiple clinical studies have shown median survival benefits of 2-4 times longer compared to systemic chemotherapy alone for conditions treated with CRS and HIPEC.
Surgery of Rectal Cancer : Potentials and Limitations - Dimitris P. Korkolis
EPIDEMOLOGY
2015 Estimates
New cases: 96,830 (colon); 40,000 (rectal)
Deaths: 50,310 (colon and rectal combined)
Death rate over last 20 years declining
Screening and improvements in treatment
Anal Cancer
This document summarizes information about anal cancer, including epidemiology, risk factors, staging, histology, and treatment approaches. It notes that anal cancer accounts for about 2% of gastrointestinal cancers. Risk factors include HPV, HIV/AIDS, and receptive anal intercourse. Treatment typically involves chemoradiation with 5-FU and mitomycin C, which results in high response rates. Additional trials have explored optimal radiation doses and chemotherapy regimens.
Reproteritoneum Anatomy and Pathology
The retroperitoneum lies between the posterior parietal peritoneum and anterior transversalis fascia. It is divided into three spaces by fasciae: anterior pararenal, perirenal, and posterior pararenal. Retroperitoneal organs include the duodenum, pancreas, kidneys, ureters, and great vessels. Fluid collections can extend between these spaces along interfascial planes. Characterization of retroperitoneal tumors involves identifying the organ of origin and patterns of spread. Specific radiologic signs like the "beak sign" can help determine the originating organ. The presence or absence of fat or other tissue components also provides clues to diagnosis.
Extralevator abdominoperineal resection(elape)
This document discusses the history and technique of the extended abdominoperineal excision (ELAPE) surgery for rectal cancer. It begins with Miles' description of the standard abdominoperineal resection (APR) in 1908. The ELAPE technique was developed to address high circumferential resection margin positivity and local recurrence rates with APR for low rectal cancers. The ELAPE surgery extends the abdominal phase of resection using total mesorectal excision principles and removes the levator muscles en bloc during the perineal phase. Initial studies show ELAPE reduces bowel perforation and positive margin rates compared to APR, with potentially lower local recurrence. However, large randomized controlled trials are still needed to establish EL
Soft tissue sarcoma (Retroperitoneal Sarcoma)
This document discusses retroperitoneal soft tissue sarcoma (RPS), including its most common histologies, clinical presentation, evaluation, treatment with surgery, radiotherapy, chemotherapy, targeted therapy, and management of recurrent disease. It provides details on surgical approaches for RPS including the importance of obtaining clear margins. It also reviews evidence on multimodality treatments including preoperative chemoradiation. Recurrence after initial treatment is high, but salvage surgery may provide a survival benefit in select patients depending on factors like tumor size and disease-free interval.
D2 gastrectomy
Laparoscopic radical gastrectomy for gastric cancer management is feasible in highly complex centers with advanced laparoscopic service with comparable oncological results to open procedures with free margins, adequate lymph node count, with a low complication rate and very low recurrence rate.
Ca rectum Management seminar 2019
seminar on ca rectum management including evolution of trials
Dr. kavita sehrawat
2019
MAMC ,DELHI
Peritoneal Carcinomatosis : Dr Amit Dangi
Here are the key steps:
1. The left subphrenic space is entered by incising the peritoneum overlying the left hemidiaphragm.
2. The peritoneum is dissected off the left hemidiaphragm in a cephalad direction towards the diaphragmatic crus.
3. The peritoneum is then stripped down the left paracolic gutter towards the pelvis, removing all peritoneal surfaces.
4. The left subphrenic peritonectomy is then completed, exposing the left hemidiaphragm and removing all peritoneal surfaces in the left subphrenic space.
Neoadjuvant therapy in colorectal carcinoma
- Several studies have shown that neoadjuvant therapy decreases local recurrence rates in colorectal cancer when compared to surgery alone. One study showed a statistically significant decrease in local recurrence with the addition of chemotherapy to preoperative radiotherapy.
- Evidence indicates that long-course chemoradiotherapy, induction chemotherapy followed by long-course chemoradiotherapy, and short-course radiotherapy are the three accepted neoadjuvant approaches, with long-course chemoradiotherapy being the most commonly used currently. Short-course radiotherapy has also shown non-inferior oncologic outcomes compared to long-course chemoradiotherapy in some studies.
What's hot (20)
Carcinoma rectum the complete aproach to how to investigate and treat a case ...
Carcinoma rectum the complete aproach to how to investigate and treat a case ...
Presentation1.pptx, radiological imaging of mesenteric ischemia.
Presentation1.pptx, radiological imaging of mesenteric ischemia.
Surgery of Rectal Cancer : Potentials and Limitations - Dimitris P. Korkolis
Surgery of Rectal Cancer : Potentials and Limitations - Dimitris P. Korkolis
Similar to Cylindrical APR
MCC 2011 - Slide 9
The document discusses different techniques for performing an abdominoperineal resection (APR) for rectal cancer. It outlines problems with the conventional synchronous APR approach and proposes changing to standardized inter-sphincteric, extra-levator, or ischio-anal APR depending on tumor location. Each technique is defined by its relationship to anatomical structures. Indications, advantages, and positioning considerations are provided for each type of APR.
Laparoscopy in obesity Dr.Nutan Jain India
This document discusses obesity and minimally invasive surgery in gynecological procedures. It provides definitions of obesity, assessments for obese patients undergoing surgery, and techniques for laparoscopic surgery in obese patients. Key points include the use of longer instruments, perpendicular trocar insertion, and positioning to accommodate excess tissue. Minimally invasive surgery is shown to be as safe for obese patients as non-obese with proper precautions. It can significantly reduce morbidity compared to open surgery for procedures like hysterectomy and lymph node dissection in endometrial cancer.
CARCINOMA RECTUM MANAGEMENT
This document summarizes the management of rectal cancer. It discusses various imaging modalities used for clinical staging such as transrectal ultrasound, CT scan, and MRI. It then covers staging, prognostic factors, principles of pathologic review, and various treatment options including surgery (local excision, transabdominal resection, low anterior resection), total mesorectal excision, laparoscopic resection, and the role of combined modality therapy with chemotherapy and radiotherapy.
Management of Rectal Cancer
A multidisciplinary approach that includes surgery, medical oncology, and radiation oncology is required for optimal treatment of patients with rectal cancer
Trans-anal Endoscopic Microsurgery TEM
Trans-anal Endoscopic Microsurgery TEM; Trans-anal Endoscopic operation TEO; Trans-anal Endoscopic Surgery TES.
Abdominal incisions
1) The document reviews various incision and closure techniques used in obstetrics and gynecology, including transverse (e.g. Pfannenstiel), vertical (e.g. midline), and laparoscopic incisions.
2) It discusses factors to consider when selecting an incision such as patient characteristics, pathology, and risk of adhesions or malignancy. It also reviews various suturing and closure methods like continuous versus interrupted sutures.
3) The ideal closure method provides good approximation with minimal risk of complications like infection, hemorrhage or wound dehiscence while allowing for the best cosmetic outcome. Layered versus mass closure techniques are evaluated.
Combined 18 clinical training--rectal surgical principles
This document discusses surgical treatment options for rectal cancer, including radical resection and local excision procedures. It emphasizes that total mesorectal excision during radical resection is optimal for most rectal cancers as it facilitates nerve preservation and complete resection, improving local control rates to less than 10%. Local excision may be adequate for early stage cancers, with local failure rates of around 20% when strict selection criteria are followed. Adjuvant chemotherapy and radiation are recommended to improve outcomes after conventional surgery for advanced cancers.
Peritoneal surface malignancy
The document discusses peritoneal surface malignancy and its treatment with cytoreductive surgery (CRS) and hyperthermic intraperitoneal chemotherapy (HIPEC). It covers the principles, indications, staging, procedures, complications and outcomes of CRS and HIPEC. Key points include that CRS aims to remove all visible tumor followed by HIPEC to treat microscopic disease. Complete cytoreduction to no visible tumor or less than 2.5mm results in better survival. Major complications occur in 30-45% of cases but mortality is low at 0-5%. CRS and HIPEC provide long-term survival for select patients with peritoneal carcinomatosis from various primary cancers.
DIEP Flap - For Breast Reconstruction
This document discusses breast reconstruction using DIEP flaps, which involves using blood vessels and tissue from the lower abdomen. The goals of breast reconstruction are to provide a natural breast contour and shape, avoid the need for external prosthetics, and help patients regain confidence. The document discusses the history of breast reconstruction and why abdominal tissue became popular. It provides details on different types of flaps and considerations for medial versus lateral perforator flaps. Key points discussed are the importance of vessel diameter, central positioning of perforators, and vascular branching patterns. The document also addresses techniques like subfascial dissection and skin-sparing approaches to breast reconstruction.
Management of Carcinoma Rectum.pptx
- Management of rectal cancer has changed dramatically in recent decades with multimodality treatment becoming standard.
- Surgery remains the primary treatment but local recurrence rates were historically high at 20-50% with surgery alone.
- Total mesorectal excision has significantly reduced local recurrence rates by completely removing the mesorectum containing the tumor and draining lymph nodes.
- Adjuvant chemoradiation or neoadjuvant chemoradiation further lower recurrence rates and improve survival compared to surgery alone.
Surgical Management of Carcinoma Esophagus
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
skin incisions
The document discusses various types of abdominal incisions used in surgery. It describes midline, vertical, transverse, and oblique incisions. Midline incisions provide good access but have a higher risk of hernia. Transverse incisions have better cosmetic outcomes and less risk of complications like hernia compared to vertical incisions. Specific incisions discussed include Kocher for gallbladder surgery, McBurney for appendicectomy, and Pfannenstiel for pelvic operations. Factors affecting incision healing and potential complications are also outlined.
21 Century Management Of Colorectal Cancer
This document summarizes the management of colorectal cancer from the perspective of a colorectal surgeon. Key points discussed include the importance of total mesorectal excision surgery, developments in less invasive surgical techniques like laparoscopic surgery, the roles of radiotherapy and chemotherapy, and the increased focus on sphincter preservation and quality of life outcomes for patients. Advances in staging techniques such as endorectal ultrasound and MRI are also reviewed.
New techniques in breast radiotherapy
This document discusses new techniques in breast radiotherapy, including partial breast irradiation (PBI). It describes several techniques for PBI including interstitial brachytherapy using catheters, intracavitary brachytherapy using the Mammosite device, and 3D conformal external beam radiation therapy. The document highlights the potential benefits of PBI such as reduced treatment time from 6 weeks to 1 week, decreased toxicity, and increased utilization of breast conserving therapy. However, it also notes limitations including the need for additional surgery with some techniques and the lack of long-term data comparing PBI to standard whole breast irradiation.
EBRT of Ca Cervix
This document discusses external beam radiation therapy (EBRT) techniques for cervical cancer. It begins by introducing cervical cancer staging and the principles of EBRT management based on tumor stage. It then covers indications for pre-operative, post-operative and palliative EBRT. The document discusses various EBRT techniques including conventional, 3D-CRT, IMRT and IGRT. It provides details on treatment planning including patient positioning, simulation, field design and dose fractionation. Finally, it covers 3D-CRT planning and discusses the rationale and caveats of IMRT for cervical cancer treatment.
EASO2011 BRS 9 Clough
This document discusses oncoplastic surgery techniques for breast-conserving surgery. It begins by reviewing the size limits and criteria for conservative breast cancer treatment. It then introduces oncoplastic surgery techniques which integrate plastic surgery to enable wider excisions and better cosmetic outcomes, extending the limits of breast conservation. Various oncoplastic techniques are described including volume replacement using latissimus flaps and volume displacement using mammoplasty techniques. Studies show oncoplastic surgery does not negatively impact oncologic outcomes while improving cosmesis, though it requires careful patient selection and training to perform.
Parastomal hernia
The document discusses guidelines for the prevention and treatment of parastomal hernias. It finds that the incidence of parastomal hernias is 30-50% depending on follow up time, with terminal colostomies having a higher risk than lateral colostomies or ileostomies. Risk factors include age, obesity, infection and surgical technique. Mesh repair during hernia surgery results in lower recurrence rates of 7-17% compared to 69.4% for primary suture repair. Laparoscopic and open intraperitoneal mesh techniques have recurrence rates of around 10%. Prophylactic mesh placement during stoma creation may decrease hernia rates.
Chest wall
This document discusses techniques for reconstructing chest wall defects following resection of damaged tissue. It presents the author's experience with 28 patients who underwent chest wall resection and reconstruction. Three main techniques are described: rigid reconstruction using polypropylene mesh and methylmethacrylate, non-rigid reconstruction with polypropylene mesh alone, and soft tissue reconstruction with myocutaneous flaps. Postoperative complications occurred in 17.9% of patients and were associated with older patient age, larger chest wall defects, and combined lung resection. The author concludes that chest wall resection and reconstruction can be performed safely and effectively in a single stage.
oncoplasty breast
1. Oncoplastic breast surgery (OPBS) combines oncological surgery with plastic surgery techniques to allow for wide excision of breast cancer tumors while maintaining the natural shape of the breast.
2. OPBS techniques have evolved since the 1980s and can be used for breast-conserving surgery, post-mastectomy reconstruction, or correction of defects after standard breast-conserving surgery.
3. OPBS is generally indicated for early-stage breast cancers less than 4cm and can extend the use of breast-conserving surgery to larger tumors. Selection depends on factors like excision volume, tumor location, and breast density.
Vakalis new techniques in breast radiotherapy
This document discusses therapeutic approaches to breast cancer treatment, focusing on radiotherapy techniques. It provides a historical overview of radiotherapy and highlights results from randomized trials demonstrating the benefits of radiotherapy after lumpectomy in reducing local recurrence rates and improving survival. Modern external beam radiotherapy techniques like 3D conformal radiation therapy and accelerated partial breast irradiation are described. Various techniques for partial breast irradiation including brachytherapy, MammoSite, and 3D-CRT are summarized along with their benefits, limitations, and results from studies. Ongoing trials evaluating partial breast irradiation are also mentioned.
Similar to Cylindrical APR (20)
Combined 18 clinical training--rectal surgical principles
Combined 18 clinical training--rectal surgical principles
More from ensteve
Evaluation of Complex Anal Fistula - EUA, EUAS OR MRI?
1. The document discusses different imaging modalities for evaluating complex anal fistulas, including endoanal ultrasound (EAUS), MRI, and their ability to classify fistulas and identify secondary extensions compared to clinical exam alone.
2. Several studies found EAUS and MRI to have higher sensitivity than clinical exam alone in identifying primary tracts, abscesses, horseshoe extensions, and internal openings.
3. Pre-operative MRI can alter surgical management by identifying complex tracts and internal openings and reducing recurrence rates when surgery follows the MRI findings.
The Management of Enterocutaneous Fistulae
Enterocutaneous fistulae are abnormal connections between the gastrointestinal tract and skin that usually develop postoperatively or due to conditions like inflammatory bowel disease. They require a multidisciplinary approach to management including resuscitation, controlling sepsis, optimizing nutrition, assessing for spontaneous closure, and potentially definitive surgery. Definitive surgery has around an 80% success rate when a formal resection is performed but recurrence is higher with complex fistulae. Abdominal wall reconstruction after surgery can be challenging and often requires techniques like components separation.
Does a Stoma Help to Prevent Leakage After a Low Anterior Resection
A stoma helps prevent leakage after a low anterior resection by diverting fecal content away from the anastomosis site. Anastomotic leak rates are lower and reoperation rates are reduced when a stoma is created. While stomas have morbidity risks of their own, they can help reduce local recurrence risks and improve survival outcomes by preventing direct seeding of cancer cells from a leak. Reinforcing the anastomosis with materials like oxidized regenerated cellulose may help reduce leak rates and diminish the need for a diverting stoma in some cases.
Surveillance for a Family History of Colorectal Cancer
Category 1 includes those at average risk, with no family history of colorectal cancer or a single first degree relative diagnosed over age 55. Screening is a fecal occult blood test every 2 years starting at age 50.
Category 2 includes those with moderately increased risk, such as a first degree relative diagnosed under age 55 or two first or second degree relatives. Screening is colonoscopy every 5 years starting at age 50 or 10 years younger than the youngest family member's diagnosis.
Category 3 includes those at potentially high risk, with features of Familial Adenomatous Polyposis or Hereditary Non-Polyposis Colorectal Cancer. Screening is complex and individualized, often involving
Averse to surgery? : The (short) surgical career of John Keats
1. John Keats was an English poet who briefly studied and worked as a surgeon's apprentice and dresser at Guy's Hospital in London from 1815-1817.
2. During this time, he was exposed to surgery, dissection, and treating patients while also developing his passion for poetry.
3. Keats admired the skill of surgeons like Astley Cooper but ultimately chose to pursue a career in poetry over medicine, leaving his dressership and not sitting the RCS exam, in order to focus on his writing.
Follow Up After Colorectal Cancer Surgery
The document discusses follow up care after colorectal cancer surgery. It reviews literature on intensive versus routine follow up. Meta-analyses found intensive follow up with frequent testing and imaging reduced mortality by 9-13% and time to relapse by around 8 months. Current guidelines recommend intensive follow up, though optimal tests and timing are not firmly established. Colonoscopy, CEA, and CT scans are commonly used in follow up.
Screening, Surveillance And Diagnosis Of Colorectal Cancer
Screening and surveillance for colorectal cancer involves assessing risk based on family history and personal medical history to determine appropriate screening methods and schedules. The National Bowel Cancer Screening Program in Australia uses fecal immunochemical testing every 2 years for average risk individuals aged 50-74, with colonoscopy for positive tests. Participation rates are around 40-50% and cancer detection rates are around 5% for those undergoing colonoscopy. Ongoing evaluation aims to improve participation and outcomes.
18. Smoking And Wound Healing
Smoking is an important risk factor for complications in wound healing. Smoking causes tissue hypoxia by reducing blood flow and impairing oxygen delivery, which inhibits collagen synthesis and decreases the body's ability to fight infection. Oxidative killing of neutrophils and reduction of wound infections can be partially restored within a few weeks of smoking cessation, but collagen synthesis may not recover as quickly. Existing evidence suggests short-term abstinence alone may not reduce complications from surgery or prevent disrupted wound healing.
16. Stress And The Git Does It Cause Crohns Disease
The document discusses the relationship between stress and Crohn's disease. It summarizes that while stress does not appear to cause Crohn's disease, stress may modulate the disease course by influencing the brain-gut axis. Stress can diminish protective intestinal factors and increase permeability through pathways like the HPA axis and sympathetic nervous system. Some studies have found an association between psychological distress levels and future Crohn's disease activity, but the evidence regarding stressful life events triggering relapse is inconsistent.
17. Oliguria In The Postoperative Patient
Oliguria is a decreased urine output that can be a sign of acute renal failure. The document discusses evaluating and managing oliguria in a postoperative patient. Common causes of postoperative oliguria include fluid loss, decreased renal perfusion, or intrinsic kidney injury. Assessment involves checking for dehydration, obstruction, or acute kidney injury risk factors. Initial management focuses on fluid resuscitation and stopping nephrotoxic drugs. Further treatment depends on whether the cause is pre-renal, renal, or post-renal.
15. Risk Of Pregnancy In Women With Congenital Heart
Women with congenital heart disease are at increased risk of complications during pregnancy due to the hemodynamic changes that occur. The risks depend on the type of heart defect and whether it involves cyanosis or pulmonary hypertension. While advances in treatment have improved survival, pregnancy remains risky especially for those with Eisenmenger syndrome or cyanotic heart disease with low oxygen saturation. Close monitoring during pregnancy is important to reduce maternal and fetal risks such as heart failure, arrhythmias, thromboembolism, preterm birth and growth restriction of the baby.
14. Ptq Injections For Faecal Incontinence
PTQ injections involve injecting silicone particles suspended in a hydrogel carrier into the internal anal sphincter to treat faecal incontinence. The silicone provides a "padding effect" to promote anal closure. Studies show PTQ injections improve anal sphincter pressures and short-term continence scores. Long-term follow up studies on larger numbers of patients are still needed to determine optimal techniques and long-term effectiveness.
13. Hyperplastic Polyposis Syndrome
Hyperplastic Polyposis Syndrome (HPS) is characterized by multiple hyperplastic polyps in the colon and rectum. While previously considered benign, hyperplastic polyps are now seen as potential precursors to colorectal cancer due to genetic mutations also found in cancer. Research shows patients with HPS have an increased risk of developing right-sided colon cancers that are MSI-high and associated with methylation of genes like hMLH1. Hyperplastic polyps may progress to cancer through either a mild or high mutator pathway involving genetic and epigenetic changes. Diagnosis of HPS requires meeting certain criteria regarding number and size of hyperplastic polyps. Management includes surveillance colonoscopies and potentially prophylactic
12. Laetrile
Laetrile, also known as amygdalin, is a substance promoted as an alternative cancer treatment since the 1970s. It is derived from apricot pits and produces cyanide when metabolized. While some claim it selectively kills cancer cells, evidence shows it is toxic and there are no well-designed studies proving its effectiveness as a treatment. Reports of benefits are unreliable and risks include cyanide poisoning and unknown purity of sources being used. Many health authorities have banned its use due to lack of evidence and risks of toxicity.
11. Pseudomembranous Colitis Images
Pseudomembranous colitis is caused by Clostridium difficile bacteria and is usually associated with antibiotic use. The bacteria releases toxins that damage the colon lining, causing symptoms like severe diarrhea. Risk factors include advanced age, hospitalization, and immunosuppression. Treatment involves stopping the culprit antibiotic if possible, rehydration, and antibiotic therapy targeted against C. difficile like vancomycin. Complications can include dehydration, perforation, and toxic megacolon requiring surgery in some cases.
9. Postoperative Ileus
Postoperative ileus is caused by neurogenic, hormonal, inflammatory, and pharmacological factors. Sympathetic overactivity and the release of corticotropin-releasing factor and nitric oxide contribute to the neurogenic and hormonal components. Inflammation is driven by macrophages and prostaglandins released during intestinal manipulation. Opioids inhibit intestinal motility pharmacologically by blocking excitatory neurons. Prevention strategies include laparoscopic surgery, which reduces inflammation, and alvimopan, a peripheral mu-opioid receptor blocker. Treatments include early enteral feeding and epidural analgesia to inhibit reflex arcs, though no single treatment is completely effective.
10. The Management Of Pseudomembranous Colitis
Pseudomembranous colitis is caused by Clostridium difficile and results in inflammation of the bowel wall. Initial management includes discontinuing antibiotics, supportive care, and isolation precautions. First line treatments are oral metronidazole or vancomycin, with metronidazole being effective in 86-90% of cases but having an 8-9% relapse rate. Vancomycin is more reliable with a 90-100% response rate and is used for patients who cannot tolerate or fail to respond to metronidazole. Relapses may require a second course of treatment or a tapering regimen of vancomycin. Surgery is indicated for complications like toxic megac
8. Cancer Metastasis Lymphatic Spread
(1) Cancer cells can metastasize by spreading through lymphatic vessels to nearby lymph nodes.
(2) The process of lymphatic metastasis involves cancer cells degrading the extracellular matrix, entering lymphatic capillaries, and traveling through the lymphatic system to lymph nodes.
(3) Lymphangiogenesis, the growth of new lymphatic vessels, is stimulated by VEGF-C and VEGF-D and can promote cancer cell entry into lymphatic vessels and spread to lymph nodes. Blocking these pathways may help prevent lymphatic metastasis.
7. Renal Dialysis Surgery
Patients with end-stage renal disease requiring dialysis have increased risks when undergoing surgery. Their medical management requires optimizing nutrition, fluid levels, blood pressure, and other factors. Careful evaluation is needed of the patient's comorbidities like cardiovascular disease. During surgery, special consideration must be given to anesthesia selection and pain management due to the patient's kidney function.
5. Carcinoid Tumour Biochemical And Radiological Testing
Carcinoid tumours are rare, slow-growing neuroendocrine tumours that can be detected through biochemical markers like 5-HIAA and chromogranin A in urine and blood, as well as through various radiological imaging techniques. Common imaging methods discussed are 111In-pentetreotide scintigraphy, MIBG scintigraphy, CT, MRI, ultrasound, and newer techniques like PET scans using different tracers. Biochemical markers and radiological imaging can help detect primary tumours, metastases, and monitor treatment response.
More from ensteve (20)
Evaluation of Complex Anal Fistula - EUA, EUAS OR MRI?
Evaluation of Complex Anal Fistula - EUA, EUAS OR MRI?
Does a Stoma Help to Prevent Leakage After a Low Anterior Resection
Does a Stoma Help to Prevent Leakage After a Low Anterior Resection
Surveillance for a Family History of Colorectal Cancer
Surveillance for a Family History of Colorectal Cancer
Averse to surgery? : The (short) surgical career of John Keats
Averse to surgery? : The (short) surgical career of John Keats
Screening, Surveillance And Diagnosis Of Colorectal Cancer
Screening, Surveillance And Diagnosis Of Colorectal Cancer
16. Stress And The Git Does It Cause Crohns Disease
16. Stress And The Git Does It Cause Crohns Disease
15. Risk Of Pregnancy In Women With Congenital Heart
15. Risk Of Pregnancy In Women With Congenital Heart
5. Carcinoid Tumour Biochemical And Radiological Testing
5. Carcinoid Tumour Biochemical And Radiological Testing
Cylindrical APR
- 1. CYLINDRICAL APR PETER HEWETT
- 4. RECTUMS OF EUROPE British Journal of Surgery Volume 97, Issue 4, pages 588–599, April 2010
- 5. Local recurrence has not improved to the same degree as seen with anterior resection after the introduction of TME. Significant reduction in tissue volume around the tumour in APR specimens compared with Anterior resection specimens Greater CRM positivity Greater local recurrence Poorer 5 year cancer specific survival
- 11. Cylindrical AP Resection Mobilisation of the mesorectum down to the origins of the levator muscles. Stoma formation and closure Patient is rotated into the prone position Extended perineal resection
- 12. Extended Perineal resection Excision of the sphincter complex Follows the inferior surface of the levators to a point laterally where they originate from the pelvic sidewall The point should be just inferior to the level where the abdominal procedure was terminated Coccyx can be removed in continuity with the main specimen Repair of defect with a gluteal flap.
- 20. Advantages (literature) Reduced rate of perforation Reduced rate of CRM 70% more tissue outside the internal sphincter / muscularispropria at the tumour 14.5mm extra tissue posteriorly and 4mm at anterior and lateral margins at the tumour.
- 21. J ClinOncol. 2008 Jul 20;26(21):3517-22. Epub 2008 Jun 9. Evidence of the oncologic superiority of cylindrical abdominoperineal excision for low rectal cancer. West NP, Finan PJ, Anderin C, Lindholm J, Holm T, Quirke P. Pathology and Tumour Biology, Leeds Institute of Molecular Medicine, University of Leeds, United Kingdom. Karolinska University Hospital, Stockholm, Sweden
- 22. ExtralevatorAPR removed more tissue from outside the smooth muscle layer per slice (median area 2120 versus 1259 mm2; P < 0·001) leading to a reduction in CRM involvement (from 49·6 to 20·3 per cent; P < 0·001) and IOP (from 28·2 to 8·2 per cent; P < 0·001) compared with standard surgery. However, extralevator surgery was associated with an increase in perineal wound complications (from 20 to 38·0 per cent; P = 0·019).
- 23. Multicentre experience with extralevatorabdominoperineal excision for low rectal cancer† N. P. West1,*, C. Anderin3, K. J. E. Smith2, T. Holm3, P. Quirke1 British Journal of Surgery Volume 97, Issue 4, pages 588–599, April 2010
- 24. Advantages Good visualisation anterior structures with plane easily seen and dissected Easy control of bleeders Decreased perforation rate One surgeon Easy to teach Easy to assist Perineal operator does not get wet Possibly less blood loss
- 25. Disadvantages Learning curve as to how far to dissect into the pelvis Unaccustomed plane Coccygeal division leaves bare bone in a potentially contaminated field. No further access to abdomen during the perineal dissection No difference in postoperative recovery Perineal wound complications
- 26. Tips If the excised sigmoid colon is very fatty amputate it so that the rectum can be delivered easily. If there is anterior attachment of the tumour take care in reflecting the rectum. If possible mobilise an omental pedicle to place in the pelvis. Remember the drain!
- 27. Tips
- 29. FIGURE 1. Pelvic Floor Reconstruction Using Human Acellular Dermal Matrix After Cylindrical Abdominoperineal Resection. Han, Jia; Wang, Zhen; Gao, Zhi; Xu, Hui; Yang, Zeng; Jin, Mu Diseases of the Colon & Rectum. 53(2):219-223, February 2010. DOI: 10.1007/DCR.0b013e3181b715b5 FIGURE 1. Use of human acellular dermal matrix for reconstruction of pelvic floor. © The ASCRS 2010. 2