Sometimes I sit and feel sad about the chair. This site is about Total Mesorectal Excision, a surgical approach to rectal cancer.
Here’s a great example of a low rectal cancer, very close to the top of the anal canal. It has irregular outer margins and (not shown on this image), it also has small peri-rectal lymph nodes.
In my country, Canada, this might receive neoadjuvant chemotherapy, then surgery. The surgery might be “AP resection”. Lastly after healing from surgery, would be radiotherapy.
This particular patient has no liver metastases, and no pelvic sidewall or paraaortic lymphadenopathy.
Here’s a different example, of a low rectal tumor definitely involving part of the top of the anal canal. Ugh, this gives me anxiety a little bit.
As a surgeon, the highly recommended mode of treatment when it comes to rectal cancer is surgery. Radiation, as well as chemotherapy, may also be administered before or after surgery. The stage of cancer, ranging from stage 1-4, the location of the cancerous growth and the main aim of the surgery will determine the type of surgery that will take place.
For the surgery to take place, some tests must be carried out so that as the surgeon, I may be in the capacity to understand the extent to which you as the patient may be affected by cancer. From the results, I will be in a capacity to dictate what your treatment and diagnosis should entail. In most cases, as a surgeon, I always recommend that patients affected by cancer should undergo surgery so as to get rid of the malignant growth completely.
Depending on the size of the growth, the rate at which it has spread and also the location, types of surgery are quite a few. The type of surgery that you may undergo as a patient will mainly be determined by the test results.
In relation to cancer in the rectum region which is located in the lower part of the large intestines. Several methods of surgery can be incorporated so as to get rid of cancer. Radiotherapy and chemotherapy are modes of treatment that may be administered before the surgery so as to ensure that the size of the cancerous growth is moderated.
The types of surgery that are administered to patients suffering from rectal cancer are of three types. Namely; Transanal endoscopic microsurgery (TEMS), local transanal resection, Total mesorectal excision (TME) and Emergency surgery.
We will now discuss the types of surgery one at a time and in a detailed manner…;
- Local transanal resection. This is an option for people who have been diagnosed with cancer at early stages. This type of surgery is administered to patients who have a very small cancerous growth and the location is normally at the lower part of the rectum. The growth is normally gotten rid of by insertion of instruments through your anus. In this type of surgery, no incisions are made as it is mostly a minor type of surgery.
- Transanal endoscopic microsurgery (TEMS). This is a form of surgery that is normally recommended for early stage cancer. The location of the tumor is normally is normally at a higher point in the rectum. As the surgeon, when carrying out this procedure I will use an instrument known as a sigmoidoscope. The sigmoidoscope is normally inserted into the rectum region through the back passage and aids in detaching the tumor from the walls of the rectum. Additionally, the instrument seals the blood vessels by use of special forceps and diathermy.
- Total mesorectal excision (TME). This is the most recommended form of surgery when it comes to rectal cancer. The surgery entails removal of the whole rectum as well as the fatty tissue located around the rectum. When this form of surgery is carried out, the risk of cancer coming back is minimal. Based on the size and position of the tumor, the surgeon will perform this type of surgery in the following ways:
- Low anterior resection: The surgeon detaches the tumor without any damage to the anus. As a result, the colon is attached to the part of the rectum that remained unaffected and your digestive system will continue to function normally after the surgery. The only side effect that may arise from the surgery is the formation of a stoma that will be present for about 8 weeks so as to allow the bowel to heal.
- Colo-anal J pouch’ surgery: This is whereby the whole rectum is taken out and the colon is attached to the anus directly. As usual, a stoma will be formed so as to allow the bowel to heal. The stoma may be present for a period of about 8 weeks.
- Abdominoperineal (AP) resection: This is an operation that is normally carried out when a growth is experienced in the lower part of the rectum. The surgery involves only getting rid of the part of the rectum that is affected. The anal sphincter muscles, as well as the anus, are also removed. As a result, a permanent stoma is formed so as to allow normal exiting of stool from the body.
In some cases, some patients may be admitted to hospital due to severe abdominal pains as well as a blockage in the rectum region due to a malignant growth. As for such a case, the surgeon may opt to carry out an emergency surgery that entails inserting a colonic stent into the anal region. The insertion will act as a temporary way of unblocking the bowel, before another form of surgery may be administered.