|
|
General information
Aim
To improve cures and reduce disabilities caused by the surgery for rectal cancer
Specimen Orientated Surgery
The TME concept embodies painstaking sharp dissection under direct vision: replacing manual extraction techniques by fastidious removal of the entire "package" without tearing its surface. The operation takes 3-5 hours
Hypothesis
That the embryology of the foetal hind-gut, a midline structure, predicates that initial cancer spread will remain within the mesorectum and thus be encompassed by the mesorectal fascia. This fascia provides the surgeon with a "navigation system" on which the efficient performance of TME is based. Involved margins after careful examination by the method of Quirke are a reliable predictor of outcome and the measure of the surgeon's success
Careful audit of the TME specimen is the key to maintaining standards
What are my chances of cure?
Overall, given optimal management, about two out of three new primary colorectal cancers can probably be cured. Provided no spread has recurred to distant sites such as the liver this rises to over 80%
Do I really have to have a permanent colostomy?
In general surgical practice about one half of rectal cancer patients undergo surgery which leaves them with a permanent colostomy. In specialist hands two out of three of these can be avoided. This is definitely an area for patients to seek a second opinion
Should I have radiotherapy?
In our opinion this decision must be made before surgery. Although post-operative radiotherapy is continuously advised in some countries we consider this a bad idea, particularly after anus-preserving operations
Do I need chemotherapy?
This is a complex decision depending upon the stage of the cancer and the quality of the surgical operation
|
|
