surgical resections and staging of colorectal carcinoma
TRANSCRIPT
Anatomy 5 – Extend of resection for carcinoma
Cecal CCA Hepatic flexure CCA
Transverse CCA Splenic flexure CCA
Descending CCA Sigmoid CCA
Proctocolectomy
• Total proctocolcetomy
• Restorative proctocolectomy (Ileal Pouch Anal Anastomosis)
• Anterior resection
– High: distal sigmoid + upper rectum, anastomosis
– Low: upper and midrectum, anastomosis
– Extended low: distal rectum, colon J-pouch, coloanal anastomosis
– Hartmann’s procedure: blind pouch, creation of mucus fistula
• Abdominoperineal resection:
– Removal of entire rectum, anal canal and anus with construction of
permanent colostomy
Routes of spread and natural history
• T1-2 means N1 in 5-20%
• T3-4: means N1 in >50%
• >4 +ive nodes predicts poor prognosis
• Colon: lymphatic spread follows major venous outflow
• Rectum: 2 routes
• M+: liver + lung + peritoneal
Staging 2/2
• Stage-specific therapy for colonic CA:
• Stage 0 (Tis, N0, M0)
• Stage I: The malignant polyp (T1, N0, M0)
• Stage I and II: Localized colon carcinoma
(T1-3, N0, M0)
• Stage III: Lymph node metastasis (Tany,
N1, M0)
• Stage IV: Distant metastasis (Tany, Nany, M1)
• Preoperative evaluation usually identifies IV disease.
• uTXNX in rectal cancer preoperatively