Minimally invasive treatment of colon cancer. Rectal cancer. Who benefits most? 2
Minimally invasive surgery methods are now available for colon cancer and for rectal cancer patients. What minimally invasive colorectal cancer treatments are available to patients today? We have many surgical methods to treat colon cancer or rectal cancer. You can do surgery laparoscopically. It means small incisions and the camera. Surgeons are doing the surgery with small holes in the abdomen. They are call “ports”. A robotic surgery plays a role. Robot-assisted laparoscopic surgery is similar to laparoscopy except that you use the DaVinci robot. Colorectal cancer could be in early stage. It could be a colon polyp that cannot be removed just endoscopically. Then a surgeon can combine the laparoscopic surgery and endoscopic method. Surgeon can remove an otherwise unresectable polyps. Rectal cancer has unique minimally invasive surgical treatment methods. Transanal endoscopic microsurgery is available for early rectal cancer, usually T1 tumor. This is a very superficial rectal cancer. You avoid the big operation to remove the whole rectum. Surgeon performs a local excision of rectal cancer. How does a surgeon choose the best method of colorectal cancer treatment? How to choose correct minimally invasive colon cancer or rectal cancer treatment? Many treatment decisions depend on the training of the cancer surgeon. Majority of cancer surgeons today are trained in the laparoscopic surgery. Laparoscopic surgery for colon cancer is happening more often in this country. Majority of colon cancer treatment can be done laparoscopically. We are still learning the benefits of robotic surgery. We have to do clinical trials to truly show the benefit of robot-assisted surgery in colon cancer. Because robotic surgery is expensive surgery. Results of robot-assisted surgery depend on both patient’s situation and training of surgeons. Robotic surgery does have some benefit in the pelvis. Because otherwise it’s very difficult to reach into the pelvis. It is difficult to visualize the structures. Robotic instrument gives you better articulation. Robotic surgery can make it easier to do the surgical procedure. We don’t have any data that results of surgery are better from robotic surgery. We don’t have any data that survival of patients are better from robotic surgery. Let’s focus on laparoscopic treatment of colon cancer. When does it make sense for patients with colon cancer to have a laparoscopic resection? When is laparoscopic surgery not advantageous for a patient? We are talking about cancer. Obviously, cure from cancer the most important goal. But convenience in laparoscopic surgery is also important. Sometimes laparoscopic surgery does make sense. Sometimes it does not make sense. That’s a very good question. A patient may choose a minimally invasive option to treat colon cancer or rectal cancer. It is very important not to have a poor oncological result. A surgeon must be able to resect the cancer with negative margin (R0 resection). A surgeon must get at least 12 lymph nodes. It means you have to do a high ligation on patient’s mesentery. Surgeon may be able to do that laparoscopically. Then laparoscopic surgery is a method of choice. Because patients do benefit from laparoscopic surgery postoperatively. They have shorter lengths of stay in hospital. Patients have less pain after laparoscopic surgical operation. Patients probably have less hernias. Because the incision is smaller in laparoscopic surgical operation in colorectal cancer. But a surgeon does not want to do laparoscopic surgery and then leave positive tumor margin. A surgeon should not leave some cancer behind. Colorectal tumor could be very large. Or the tumor could be growing into other organs. Colon cancer could be growing into a duodenum or retroperitoneum or kidney or liver. Then a surgeon has to do a big en bloc resection. It means the following. Cancer is removed all together with other adjacent organs. In such situations laparoscopy does not make sense. We also have some patients that will not tolerate laparoscopy. Some patients have problems with their lungs. Other patients have heart problems. They may not be able to tolerate laparoscopy. Because laparoscopic cancer surgery requires different positioning of the patient. Laparoscopy requires insufflation of the abdomen with carbon dioxide. Some patients will not tolerate that. Then colorectal cancer tumor is removed via open surgery. It is all about patient selection.
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