la chirurgia mini-invasiva delle neoplasie dell’apparato digerente€¦ · istituto nazionale dei...
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Paolo Delrio
Direttore UOC Oncologia Chirurgica Colorettale
Istituto Nazionale dei Tumori di Napoli
Fondazione “G.Pascale”
Approccio chirurgico ai tumori della
giunzione retto-sigmoidea
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Rectosigmoid cancer
Anatomical definition
A tumor is classified as rectal if
• lower margin lies less than 16 cm from the anal verge or
• any part of the tumor is located at least partly within the supply of
the superior rectal artery
Anatomic Transition from Sigmoid to Rectum
In the sigmoid colon, approximately 12 to 15 cm from the dentate
line, the tenia coli fuse to form the circumferential longitudinal
muscle of the rectal wall.
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Rectosigmoid cancer: location
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Rectosigmoid cancer:
radiological definition
Tumours below peritoneal reflection: RECTAL CANCER
Tumors above peritoneal reflection: SIGMOID CANCER
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Rectosigmoid cancer: algorithm
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Rectosigmoid cancer: surgical approach
Wide resection of colonic segment containing the tumour
At least 5 cms of proximal and distal colon
Adequate lymphatic resection
Adequate mesocolic excision
To the origin of the vessels (CME)
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Rectosigmoid
cancer:
the surgery
ANTERIOR
RESECTION
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Rectosigmoid cancer: the nodes
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Rectosigmoid cancer: the nodes
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Quality of colorectal resection
Intact envelope
The pathologist checks for the
quality of the specimen
Central Vascular ligation
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Rectosigmoid cancer: the nodes
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The basis of colorectal resection
Adequate lenght
Intact envelope
The pathologist checks for the
quality of the specimen
TISSUE MORPHOMETRY
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Quality of colorectal resection
The intact envelope
The pathologist checks for the
quality of the specimen
Central Vascular ligation
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Sezione dei vasi
benci arteria vena
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MIS and colorectal cancer
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New Approaches
Mini lap instruments
Fluorescence
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Complications/Prevention
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MIS and colorectal cancer
No trial showing superiority of lap over open surgery but equivalence is enough
Patients compliance and demand
Market pushes
Eventually in PDTA
High volume centers/MDT approach
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New Approaches
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Conclusions
Surgical approach to rectosigmoid cancer is standardized
Accurate report is mandatory to evaluate results
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MIS and colorectal cancer
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Benefits of Laparoscopic Surgery
• Cosmetic
• Less pain
• Speedier recovery/shorter hospital stay
• Fewer adhesions (scar tissue)
• Fewer wound infections
• Fewer post-operative complications
• Photographs/video/magnified view
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Type of anastomosis
HS vs stapled
End to End vs Side to End
Single vs Double Layer
Sealed vs naked
No difference among