Preparation for Colorectal Cancer Surgery
In general, patients with rectal cancer are elderly, and their
medical condition should be optimized preoperatively.
Prophylactic antibiotics and maintenance of normothermia
intraoperatively have been demonstrated to reduce postoperative
morbidity from wound infections. Although
mechanical bowel preparation is routinely performed, it is
unclear if this has a positive influence on outcome. The
presence of malignant disease, prolonged operative time,
pelvic surgery, and the positioning requirements of the
patient predispose to thromboembolic events.Deep venous
thrombosis prophylaxis with compression stockings and
pneumatic compression devices with or without subcutaneous
heparin is standard. For people who will require a
temporary or permanent stoma, preoperative consultation
with an enterostomal therapy nurse facilitates proper siting
of the stoma, patient education, and acceptance.
Surgical Therapy
The goals of surgical therapy are to remove all disease and
maximize the potential for long term survival while minimizing
the impact of treatment on quality of life. Surgical
therapy for cure may be divided into local approaches and
radical approaches. Both approaches may be combined
with chemoradiation.With radical approaches, bowel continuity
may be restored or the patient may be left with a
permanent colostomy.
Local Therapy
Local therapies include snare polypectomy, local excision
(wedge resection of the tumor either by endo-anal
approach or by transanal endoscopic microsurgery), or
endocavitary radiation. There are many advantages of local
therapies, including minimal postoperative morbidity and
mortality and rapid postoperative recovery. Local therapy
minimizes the impact of rectal cancer treatment on long
term function and in some cases is the only alternative to
permanent colostomy. However, by definition, local therapies
leave all lymph node-bearing tissue in situ. Thus, the
major concern with local therapy is undertreatment.
Criteria for lesions appropriate for local therapy with curative
intent are evolving and controversial. Today, most
experts agree that < 10% of rectal cancers are appropriate
for curative intent local therapy.
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