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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