Surgical management- benign and malignant tumors of rectum

1. SURGICAL MANAGEMENT-
BENIGN &MALIGNANT TUMORS RECTUM
TARA RAJENDRAN
120201468

2. Rectal cancer
Rectal cancer is a cancer deriving from abnormal cell growth in the lining or epithelium of
the rectum. Rectal and colorectal tumours are genetically considered to be the same
cancer. Rectal cancer is a serious, but highly curable form of cancer if found early.

3. ◼Local operation
◼Abdominal operation
◼Extensive operative
◼Palliative operation

4. ◼Polyps
◼Endometrioma
◼Hemangioma
◼Gastrointestinal stromal tumours
B E N I G N
T U M O U R S

5. POLYPS RELEVANT TO THE RECTUM
1) VILLOUS ADENOMA
2) FAMILIAL ADENOMATOUS
POLYPOSIS
3) HYPERPLASTIC POLYPS
4) INFLAMMATORY PSEUDOPOLYPS
5) JUVENILE POLYP

6. ▪ Hormonal manipulation
▪ Total abdominal hysterectomy and bilateral salpingoophorectomy
ENDOMETRIOSIS
▪ Excision ( at lower part of rectum)
▪ Selective angiography and embolisation
HEMANGIOMA
TRANSANAL ENDOSCOPIC MICROSURGERY TECHNIQUE
POLYP

9. MECHANICAL BOWEL PREPARATION : PURGATIVE, ENEMA
COUNSELLING OF STOMAS AND COMPLICATION OF PROCEDURE
CORRECTION OF ANAEMIA AND ELECTROLYTE IMBALANCES
PROPHYLACTIC ANTIBIOTICS : CEFUROXIME 750MG +
METRONIDAZOLE 500 MG
CATHETER INSERTION
PREOPERATIVE PREPARATION
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10. SMALL, LOW GRADE, MOBILE
(T1) LESION WITHIN 10CM OF
ANAL VERGE
TECHNIQUE:
TEM ( TRANSANAL
ENDOSCOPIC
MICROSURGERY)
COMBINED WITH
CHEMOTHERAPY AND
RADIOTHERAPY
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LOCAL OPERATION

11. PRINCIPLES
AIM:
RADICAL EXCISION OF RECTUM, MESORECTUM
RESTORE GIT CONTINUITY AND CONTINENCE
CHEMORADIOTHERAPY
PREOPERATIVE: REDUCE TUMOR SIZE TO ALLOW CURATIVE
SURGERY
POST-OPERATIVE: REDUCE LOCAL RECURRENCE
PATIENT UNFIT FOR RADICAL SURGERY : LOCAL PROCEDURE
ABDOMINAL SURGERY
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12. TUMORS OF LOWER THIRD OF RECTUM THAT ARE
UNSUITABLE FOR SPHICTER- SAVING PROCEDURE
POSITION : LLOYD- DAVIES-ALLEN
TWO SURGEONS :
SIGMOID COLON EXCISED
ABDOMINAL ( ANTERIOR AND LATERAL OF RECTUM &
DEEPENED)
PERINEAL ( CLOSE ANUS, POSTERIORLY AROUND RECTUM
& DEEPENED)
ANUS AND RECTUM REMOVED THROUGH PERINEAL WOUND
COLOSTOMY AT 2.5CM ABOVE SPINOUMBILICAL LINE
1.COMBINED ( ABDOMINAL & PERINEAL ) EXCISION OF RECTUM
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13. SPHICTER-SAVING OPERATION
HIGH (5CM) OR LOW (2CM)
ABDOMEN INCISED, RECTUM MOBILISED TO PELVIC FLOOR
EXCISE RECTUM AND SIGMOID COLON
CONTINUITY RE-ESTABLISHED BY DOUBLE STAPLING METHOD
(STRAIGHT /J-SHAPED) OR COLOANAL ANASASTOMOSIS VIA
TRANSANAL ROUTE
PURSE- STRING SUTURE IN STUMP
EXAMINE ‘DOUGHNUTS’
A STOMA IS DONE FOR SAFE HEALING OF ANASTOMOSIS
IRRIGATION OF RECTAL LUMEN WITH 1% CETRIMIDE / TME /
NEOADJUVANT RADIOTHERAPY
AVAILABLE AS LAPAROSCOPIC ANTERIOR RESECTION
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2.ANTERIOR RESECTION

15. 3.HARTMANN’S OPERATION
RECTUM EXCISED THROUGH AN ABDOMINAL INCISION
COLOSTOMY AND CLOSURE OF ANORECTAL STUMP
PERITONEUM OVERSEWN TO COVER PELVIC DEFECT
SUITABLE FOR :
ELDERLY PATIENT
PATIENT WITH CONCERN OF ANAL SPHICTER FUNCTION OR VIABILITY
OF ANASTOMOSIS

16. RADIOTHERAPY
PALLIATIVE : INOPERABLE
PRIMARY TUMOR/ LOCAL
RECURRENCE
PRE OPERATIVE: CAN BE
COMBINED WITH
CHEMOTHERAPY TO SHRINK
TUMOR TO SURGICAL SIZE
POST- OPERATIVE :REDUCE
LOCAL RECURRENCE RATE
INTRACAVITY
CHEMOTHERAPY
FOLFOX
FOLINIC ACID- LEUCOVORIN
5- FLUOROURACIL
OXALIPLATIN
INTRAPORTALLY DURING
AND IMMEDIATELY AFTER
OPERATION
ADJUVANT THERAPY

17. BAILEY AND LOVE’S SHORT PRACTICE OF SURGERY; 26 TH EDITION;
WILLIAMS, BULSTRODE, O’CONNELL; CRC PRESS
HTTP://WWW.CANCERRESEARCHUK.ORG/ABOUT -CANCER/CANCERS-IN-
GENERAL/TREATMENT/CANCER-DRUGS/FOLFOX
R E F E R A N C E
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