Laparoscopic/ Robotic Surgery for Colon (large bowel) and Rectal Cancer
There is vast amount of scientific research which supports the use of laparoscopy for operating Colon and Rectal cancer. Majority of the Colorectal Cancer, world over, are now treated by laparoscopic or robotic method. The pelvis is a confined space where operating is difficult due to lack of space. But in laparoscopy, the magnification and illumination make the surgery much easier.
Both in Colonic Surgery and Rectal Surgery, removing the tumour with all its layers (mesorectal and mesocolic fascia) with good margins of normal bowel is extremely important. This can be achieved accurately with the help of laparoscopy.
Due to the advantage of vision, magnification and instrumentation, it is possible to avoid a permanent stoma even in Rectal Cancers that are very low lying.
Sphincter Saving Surgeries for Low Rectal Cancers
One of the most feared aspect of rectal cancer surgery is possibility of having a permanent stoma.
In India, social stigma attached to a stoma significantly affects the patient’s quality of life. There has been tremendous advancement in the management of rectal cancer which helps in avoiding a permanent stoma. Some of them are using MRI for imaging rectal cancer, using chemotherapy and radiation before surgery and a better understanding of structure and function of rectum.When these are combined with a good surgical technique, a lot of patients can avoid a permanent stoma which would not have been the case a few years earlier.
Even when the Rectal Cancer is very close to the anal opening, in certain select cases a permanent stoma can be avoided by two surgical techniques – Ultra Low Anterior Resection or Intersphincteric Resection. In both these surgeries, the entire rectum is dissected almost till the anal opening and then the tumour is resected with good margins above and below. To achieve such precise and deep dissections laparoscopy and robotic surgical techniques are immensely helpful.
Trans Anal Surgery
Early Stage Rectal Cancers which are still confined to mucosa of the rectum can be removed from the anal opening. This avoids a surgery from the abdomen. This is called a Trans Anal Surgery. It requires a special equipment fitted with camera unit and ports for smaller instruments to do the surgery.
Lateral Pelvic Node Dissections
Certain advanced rectal tumors may spread to the lymph nodes in the pelvis which are beyond its covering layers (mesorectal fascia). Removal of these nodes is essential to remove all the gross disease and also for prognostication. This procedure can be achieved by open surgery or laparoscopic or robotic surgery.
Cytoreductive Surgery and HIPEC for Colorectal Cancer
Sometimes the Colorectal Cancer may grow beyond the confines of the bowel wall. In such cases the cancer cells gain access to the whole of abdominal cavity. The entire abdominal cavity is covered with a layer called peritoneum and the cancer cells can deposit on this layer. This can be diagnosed by CT, MRI and laparoscopy.
When the disease that has spread to this layer (peritoneum) is limited, the peritoneum can be stripped and removed so that all visible cancer nodules can be removed. This is called Cytoreductive Surgery.
To remove all the cancer nodules sometimes it is necessary to remove part of the bowel, stomach and other structures as well. When a complete removal is achieved, the microscopic (not visible to naked eye) cancer disease in the abdomen can be treated further with heated chemotherapy drugs instilled in the abdomen after the surgery. This is called HIPEC.