Laparoscopic and Minimally Invasive Resection of Malignant Colorectal Disease
ABSTRACT Minimally invasive surgery for colorectal cancer is a burgeoning field of general surgery. Randomized controlled trials have assessed short-term patient-oriented and long-term oncologic outcomes for laparoscopic resection. These trials have demonstrated that the laparoscopic approach is equivalent to open surgery with a shorter hospital stay. Laparoscopic resection also may result in improved short-term patient-oriented outcomes and equivalent oncologic resections versus the open approach. Transanal excision of select rectal cancer using endoscopic microsurgery is promising and robotic-assisted laparoscopic surgery is an emerging modality. The efficacy of minimally invasive treatment for rectal cancer compared with conventional approaches will be clarified further in randomized controlled trials.
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ABSTRACT: Colon cancer remains a significant clinical problem worldwide and in the United States it is the third most common cancer diagnosed in men and women. It is generally accepted that most malignant neoplasms of the colon arise from precursor adenomatous polyps. This stepwise progression of normal epithelium to carcinoma, often with intervening dysplasia, occurs as a result of multiple sequential, genetic mutations-some are inherited while others are acquired. Malignant polyps are defined by the presence of cancer cells invading through the muscularis mucosa into the underlying submucosa (T1). They can appear benign endoscopically but the presence of malignant invasion histologically poses a difficult and often controversial clinical scenario. Emphasis should be initially focused on the endoscopic assessment of these lesions. Suitable polyps should be resected en-bloc, if possible, to facilitate thorough evaluation by pathology. In these cases, proper attention must be given to the risks of residual cancer in the bowel wall or in the surrounding lymph nodes. If resection is not feasible endoscopically, then these patients should be referred for surgical resection. This review will discuss the important prognostic features of malignant polyps that will most profoundly affect this risk profile. Additionally, we will discuss effective strategies for their overall management.
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ABSTRACT: Colorectal metastases represent the most common hepatic malignancy, and experience has shown that surgical resection may offer long-term cure in select patients. Advances in operative technique and adjuvant therapy have increased 5-year survival rates to more than 50%. During the last decade, the introduction of laparoscopic liver resection has progressed from a novelty to a viable surgical option. With the growing enthusiasm for laparoscopic hepatectomy, multiple centers are utilizing a minimally invasive approach to hepatic colorectal metastases. As with any new surgical procedure, several concerns have arisen with laparoscopic hepatectomy. These include the safety of this procedure as well as its oncologic integrity. Despite these concerns, recent series have demonstrated the equivalence of laparoscopic and open hepatectomy for colorectal metastases, resulting in many of these fears being put to rest. Given these promising results, centers that have developed the necessary expertise to safely perform laparoscopic hepatectomy should begin to apply this approach to hepatic colorectal metastases.Current Colorectal Cancer Reports 06/2011; 7(2):161-167. DOI:10.1007/s11888-011-0087-0
- Seminars in Colon [amp ] Rectal Surgery 12/2009; 20(4):181-184. DOI:10.1053/j.scrs.2009.08.007