Chirurgická a miniinvazivní léčba kolorektálního karcinomu

Title in English Surgical and mini-invasive treatment of colorectal carcinoma


Year of publication 2011
Type Article in Periodical
Magazine / Source Onkologie
MU Faculty or unit

Faculty of Medicine

Field Surgery incl. transplantology
Keywords colorectal carcinoma; treatment; miniinvasive; endoscopy; laparoscopy
Description The incidence of the colorectal carcinoma has been increasing. Only a multimodal treatment provides the best results. Surgical R0 resection of all tumour sites is the goal of all treatment regimes. The advance in medical care and technologies has brought about a tendency to both miniinvasive methods and extended surgery. Material and methods: A survey on the literature in relation to our experiences has been conducted. Results: Endoscopic submucosal dissection, transanal endoscopic microsurgery, laparoscopy, open surgery and cytoreduction surgery with the hyperthermic intraperitoneal chemotherapy. Aside of the physical examination, these are key pre-operational staging examinations: coloscopy, endoscopic ultrasound that chooses candidates for an endoscopic treatment (T1sm1,N0,M0), CT that chooses between ideal laparoscopic patients (T2 N1) and open surgery, and distinguishes between resectable and non-resectable, or MRI that does the same job in rectal cancer. It is worth performing peritonectomy in somehow limited peritoneal spread with similar results as in liver metastases. Laparoscopy reaches the same oncologic results as the open surgery does. The ideal neoadjuvant therapy ought to last for three months to six months maximum. The neoadjuvant rectal radiation does not affect the long term survival but enables continent resections and lowers the local recurrence rate up to four times, mainly in low lying or large tumours. The news is the total mesocolic excision that similarly to the total mesorectal excision provides fewer local relapses and higher long-term survival. Conclusion: Similarly to anti-tumoral medical therapy, the surgery has been developing as well. It is necessary to enrol the patients into suitable databases to state the proper position of all surgical methods in the multimodal treatment algorithm.

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