From mininvasive to maxinvasive surgery in colorectal cancer: Modern evolution of oncologic specialized units

Abstract

In the last years a wide range of new technique offers the possibility to have R0 resection in colorectal cancer. We report our experience about Single Port Laparoscopic Surgery (SPL) for not advanced right colon cancer and about pelvectomy with cilindric Abdominal Perineal Resection (APR) for advanced rectal cancer. SPL offer mainly cosmetic advantages but also quicker recovery. No touch technique with adequate surgical margin and lymphectomy were respected. Operative time of SPL was 85-115 minutes, the incision was 5 cm long. There were no complications. Length of hospital stay was 4-6 days. With advanced pelvic cancer, pelvic exenteration with en-bloc resection is indicated. Then we propose a case of a 55 years old woman with a pelvic recurrence from a metastatic rectal cancer involving the right obturator fossa, the vaginal stump, the right ureter. Modern surgical technique give us the chance to offer the most appropriate oncologic surgical treatment.

Radical surgical treatement in pelvic advanced cancer

“…= Vaginal or urinary or pelviperineal reconstructions are recommended in all cases where the patient's condition allows extended operation, to fill the pelvic dead space resulting from the dissection and to minimize the mutilating consequences of the process (35-45). = Pelvic lymphadenectomy is required, especially if it hasn't been previouslly performed (25,(46)(47)(48)(49)(50)(51)(52). = Residual microscopic disease risk requires postoperative adjuvant chemotherapy (53,54).…”

“…= As locally advanced pelvic tumors cause extreme suffering (pain, bleeding, sepsis, etc. unresectable tumors can sometimes be surgically removed operated palliatively (22,46,47,(55)(56)(57)(58). Better results might be obtained in the future through minimally invasive surgery, new radiation techniques (including intraoperative radiation), the application of hyperthermia and better selection of cases through the study of immunohistochemical receptors, angiogenesis factors, apoptosis factors, parameters that can later on explain the particular development of these tumors (6,39,(59)(60)(61)(62)(63).…”

“…TPE is indicated for massive invasive pelvic tumors with a real chance of cure, (complete tumoral resection with no residual disease). Absolute contraindications of the method include visceral and peritoneal metastases, or massive invasion of the pelvic bone (22,25,47,53,64,65).…”