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Surgery for Rectal Cancer Mr Darren Tonkin Colorectal Surgeon Calvary North Adelaide
Rectal Cancer ,[object Object],[object Object],[object Object],[object Object],[object Object]
Rectal Cancer ,[object Object],[object Object],[object Object],[object Object],[object Object]
Surgical considerations “What is a surgeon thinking?” ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
The Patient ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
The Tumour ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Rectal Anatomy 15   cm High Anterior Resection Low Anterior Resection Ultra-low Anterior Resection Abdominoperineal Resection (APR)
Endorectal Ultrasound
Endorectal   Ultrasound
MRI Circumferential Resection Margin (CRM)
Pre-operative Chemoradiotherapy Before After
Pre-operative Chemoradiotherapy ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Total Mesorectal Excision ,[object Object],[object Object],[object Object],[object Object]
Bill Heald ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Local Recurrence What is Important? ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
TME   ,[object Object],[object Object],[object Object]
TME
TME
TME Leak Rate ,[object Object],[object Object],[object Object],[object Object]
TME ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Modified TME ,[object Object],[object Object],[object Object]
Modified TME 5 cm 5 cm
The Technique Pre-operative ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
The Technique Set-up ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Operative Position
The Technique Colonic Mobilisation ,[object Object],[object Object],[object Object],[object Object]
Sigmoid Mobilisation “Ureter” Ureter
Splenic Flexure Mobilised
High Ligation of Inferior  Mesenteric Artery
Ligation of Inferior Mesenteric Vein
Full Bowel Mobilisation
The Technique Posterior Rectal Dissection ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
St Mark’s Retractor
The Technique Posterior Rectal Dissection
The Technique Posterior Rectal Dissection
The Technique Anterior Rectal Dissection ,[object Object],[object Object],[object Object]
The Technique Anterior Rectal Dissection
The Technique Transection of Rectum ,[object Object],[object Object],[object Object],[object Object],[object Object]
Transverse Staple Line Rectal Stump
The Technique Preparation of Proximal Bowel ,[object Object],[object Object],[object Object],[object Object],[object Object]
The Technique Preparation of Proximal Bowel
The Technique Preparation of Proximal Bowel
The Technique Preparation of Proximal Bowel
Transected Bowel Pedicle
Staple Gun Head
The Technique Anastomosis ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Mid-rectal Anastomosis Inserting the Staple Gun
Midrectal Anastomosis
Resected Specimen Low anterior resection Abdominoperineal resection
Summary ,[object Object],[object Object],[object Object]
Stomas ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Stomas ,[object Object],[object Object],[object Object],[object Object]
Postoperative Adjuvant Therapy ,[object Object],[object Object],[object Object],[object Object],[object Object]
Postoperative Bowel Function ,[object Object],[object Object],[object Object],[object Object],[object Object]
Conclusions ,[object Object],[object Object],[object Object]

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