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The first 25 slides, exactly as they appear. The full deck has 79 content slides.
General Surgery
Perspective on Colonic Neoplasms (B)
Built from Maingot's Abdominal Operations
What’s inside
10 sections · 79 slides
Overview
- What this topic covers
Colon tumours as a surgical problem
What is being removed, and how common it is
- The large bowel
- Colon tumours as an indication for operation
- Histology of colonic neoplasms
- Colon cancer cut across the bowel wall
- What a cancer specimen has to show
Where colorectal cancer comes from
Diet, and the limits of blaming diet
- Cause of colorectal cancer
- Dietary fibre and cooked meat
- Limits of dietary prevention
Screening the colon
Why it works, and which test does what
- Effect of screening on mortality
- Features that make colorectal cancer suit screening
- The precancerous polyp
- Polyp seen at colonoscopy
- Removing a polyp through the scope
- Falling incidence of colorectal cancer
- Stool-based screening and compliance
- Anatomic evaluation of the colon and rectum
- Ways to inspect the whole colon and rectum
- Total colonoscopy as the standard screening test
- Flexible sigmoidoscopy and air contrast barium enema
- Computed tomographic colonography
- Virtual colonoscopy as a misnomer
- Computed tomographic colonography of a bowel mass
- Indications for CT colonography
- Limits of colorectal cancer screening
Risk, family history and genetics
Who needs watching earlier than 50
- Family history as a risk factor
- Identifying patients at risk of genetic syndromes
- Endoscopy-on-demand and the shift in responsibility
- Inherited colorectal cancer syndromes
- Familial adenomatous polyposis
- Colon lined with multiple polyps
- Attenuated familial adenomatous polyposis
- MYH-associated polyposis
- Hereditary nonpolyposis colon cancer
- Share of colorectal cancer explained by known syndromes
- Genetics as the future of screening
Getting the patient ready
Finding the tumour, marking it, cleaning the bowel
- Preoperative localisation of colonic neoplasms
- Synchronous pathology
- Options when the scope cannot pass the lesion
- Water-soluble contrast enema
- Intraoperative colonoscopy
- Colonoscopy after urgent operation
- India ink marking of tumour location
- Loss of tactile feedback in laparoscopic resection
- Mechanical bowel preparation
- Practice around bowel preparation
The obstructed colon
When there is no time to clean the bowel
- Obstruction that prevents preoperative preparation
- Options for the obstructed unprepared colon
- Subtotal colectomy with ileocolic anastomosis
- Resection with on-table lavage
- Staged resection with stoma
- Expandable metallic stenting as a bridge
The move to laparoscopic colon surgery
Uptake, training, evidence and standards
- 1990s
- Measuring uptake through resident case logs
- Laparoscopic operation in progress
- Timing of laparoscopy for colon cancer
- Laparoscopy as an alternative route, not a new operation
- Simulation in surgical training
- The Fundamentals of Laparoscopic Surgery programme
- Trainees at a laparoscopic skills station
- FLS certification requirements
- Computer-based simulation and credentialing
- Erosion of open surgical skills
- The learning curve and commercial pressure
- Claimed advantages against real costs
- Evidence behind the growth of laparoscopy
- Contraindications to laparoscopic resection
- Oncologic endpoints for laparoscopic cancer surgery
- Lymph node harvest as a quality measure
- Cancer spread within a lymph node
Technologies still being tested
Robotics, single-port access and NOTES
- Experimental approaches in colorectal surgery
- Status of robotics, single-port access and NOTES
- Introducing expensive new technology
Pulling it together
What to carry away from this topic
- Key points on screening and cause
- Key points on genetics and preparation
- Key points on laparoscopy
- References
- References (continued)
- Maingot's Abdominal Operations, 12th Edition