Surgical intervention is often the main method of treatment of the initial stages of colon cancer. Types of operations in malignant tumors of the body are slightly different, so are described separately.
Colon cancer - surgery in Israel
Open colectomy in Assuta
Colectomy sometimes referred hemicolectomy, colectomy partial or segmental resection. The operation involves the removal of the affected colon segment and the nearest lymph node. If it is performed through an incision in the abdomen, it is called an open colectomy.
The day before the surgery is performed complete cleaning of the patient bowel with laxatives and enemas. Colectomy is performed under general anesthesia.
During surgery, the surgeon makes an incision in the abdomen. Removes part of the colon tumor and a small segment of a healthy colon tissue on either side of malignancy. Typically, the resection is carried from one quarter to one third of the colon, the amount depends on the size and location of the tumor. Produce excision and nearby lymph nodes. The remaining part of the intestine is connected.
After operation possible pain and probably require medication for two or three days. The first two days, the patient receives intravenous nutrition, fluid intake is limited, since the intestine needs time to recover. But such resection rarely cause any serious problems with the digestive function, and a few days later the patient is able to take solid food.
For such a major surgery it is important that the general state of health was as good as possible, but in some cases, surgery is needed immediately. If the tumor is large and blocked colon, the doctor can use the colonoscope to install a stent (metal or plastic construction) inside, to remove the stenosis (narrowing) and prepare for operation in a few days.
When there is no possibility to place the stent or tumor resulted in the formation of ulcers, surgery may be needed without delay. Typically, during its holding tumor removed, but instead to connect the remaining bowel segments, the upper part of the colon is attached to the artificially created opening in the abdomen -colostomyfor removing waste. Usually it is only temporary. Sometimes the end of the small intestine to form the output of the stoma, is called to withdraw iliostoma. To attach removable stoma bag (incontinence bag) for collecting feces. After the patient recovers removed intestinal stoma, fasten the ends of the colon or ileum is connected to the large intestine.
Surgery for colon cancer - laparoscopic colectomy in Assuta
During laparoscopic surgery to remove affected segment of the colon and surrounding lymph nodes in some initial phases of colon cancer. Performed a series of small incisions, through which introduced special tools for surgery. One of them is a laparoscope equipped with a small video camera. This type of surgery requires the same preparation and the same type of anesthesia, as an open colectomy.
Thanks to a small incision, patients recover faster and experience less pain than after standard colectomy.
This kind of operation can only be done surgeon specially trained and possessing experience in laparoscopic colectomy.
Surgery for colon cancer - polypectomy
In the initial stages - I 0 and cancer tumor resection surface and a minor amount of surrounding tissue produced via the colonoscope, avoiding abdominal incisions. During polypectomy cancer polyp resecting the segment by cutting his leg (area resembling a foot fungus).
Rectal cancer - surgery in Israel
As a rule, the operation is regarded as the basic method of treatment of colorectal cancer. The tumor can be removed with the help of several types of surgery.
Local transanal resection of the rectum in Assuta
This type of operation also has another name - transanal removal and produced by instruments that are introduced through the anus, mainly under local anesthesia. During the operation, the tumor was removed and healthy segment of rectal tissue. Indications - tumor on the T1 N0 M0 Stage I rectal cancer is small and is not too far from the anus.
Transanal endoscopic microsurgery (TEM) in Assuta
Indications for surgery - a tumor in stage I T1 N0 M0 rectal cancer, is far from the anus to be able to apply the standard transanal resection. Through the anus is introduced specially designed device - operating proctoscope. It allows you to perform an operation with high precision and accuracy. This type of surgery is performed only in certain centers, as it requires special medical equipment and surgical services with specific training and experience.
Low anterior resection of the rectum in Assuta
Indications for this operation: a number of malignant tumors in cancer stages I and II for the most part and III phases located near the connection to the large intestine. During surgery produce removal of the affected segment of the colon. The large intestine is then combined with a preserved part of the rectum.
Low anterior resection is like most abdominal operations. Before surgery the patient for bowel cleansing takes laxatives and enemas do. The operation is performed under general anesthesia. The surgeon performs incision in the abdominal cavity. Then removes the tumor and some of the healthy tissue on either side of malignancy, as well as nearby lymph nodes, adipose and fibrotic tissue around the rectum. The large intestine is then again connected to the rectum, so there is no need for a permanent colostomy.
In the case where an operation performed before the irradiation and chemotherapy, Tend to make a temporary ileostomy (the last of the small intestine - ileum fed to an opening in the abdominal cavity). Typically, eight weeks it is removed, re-connecting the intestine.
Hospitalization is from four to seven days, depending on your overall health, the recovery period in a house - from three to six weeks.
Proktektomiya with koloanalnym anastomosis in Israel
Indications: number of malignancies in stage I colon cancer and most in phases II and III, located in the middle and lower third of the colon. During proktektomii completely removed rectum. The large intestine is then connected to the anus, creating koloanalny anastomosis. Complete removal may be necessary in connection with the total mezorektumektomiey (TME), when producing excision of all lymph nodes around the rectum. The procedure is complex, but modern techniques have made it feasible.
Sometimes koloanalnom anastomosis reservoir formed of two loops of the colon or by expanding segment (koloplastiki). It becomes a place to store the feces instead of the rectum. It may require temporary opening - ileostomy for about 8 weeks while healing the intestines. Then, the second operation for restoring body and closing ileostomy.
Proktektomiya requires general anesthesia. The usual length of stay is four to seven days. The recovery time in a home can take three to six weeks.
Abdominoperineal extirpation of the rectum (BPE) in Assuta
Indications: number of tumors at stages I and rectal cancer in large part II or III, localized near the anus, particularly if malignancy germinated in the sphincter muscle.
In the process of extirpation surgeon performs a single incision in the abdominal cavity, the other - in the crotch area around the anus. In the last section of the anus and remove the surrounding tissue, including the sphincter muscles. Since the anus is removed, you will need a permanent colostomy.
This operation requires general anesthesia. The period of stay in the hospital is from four to seven days, the rehabilitation period - from 3 to 6 weeks.
Pelvic exenteration appoint rectum adjacent organs during the germination of the tumor. Operation is extensive in nature when performed removal of rectum, bladder, prostate in men and the uterus in women, if these bodies have spread metastases. After this surgery will require a colostomy. When the bladder is removed, the patient will need urostomy (opening formed in the front side of the abdomen for urine excretion from the body, which is collected in an external urine collection bag).
Side effects of colorectal surgery
Possible unwanted effects depend on several factors, including the degree of surgery and general health of the patient before surgery. Most people will be pain after surgery, but can be used to eliminate them, if necessary, medication. The problem is usually solved with food for several days after surgery.
Other common adverse effects may include: bleeding, blood clots in the legs, damage to nearby organs during surgery, infection due to the separation ends of the intestine; divergence slit in the abdominal cavity, causing an open wound. Perhaps the development of scar tissue - adhesions that can block the intestines, and need further surgery in some cases. Therefore, it is important to high quality health care, which provides for the operation of the chosen clinic.
Colostomy or ileostomy
Some patients may need temporary or permanent colostomy (or ileostomy) after surgery. You will need to time to adjust and make some adjustments in lifestyle. Also will need help to learn how to manage and care for her. Specially trained nurses or therapists to help with the solution of this problem. They meet with the patient in the hospital before surgery to discuss this issue and noted the place to open. After the training operation is carried out.
Sexual function and fertility after colorectal surgery
If the patient - a man, the abdominoperineal extirpation of the rectum lead to erectile dysfunction and deny the ability to achieve orgasm. In some cases, the pleasure during orgasm becomes less intense. The aging process is the cause of some of these changes, but they have become much more severe after surgery.
This type of surgery damages the nerves that control the ejaculatory process that leads to orgasm without sperm. Sometimes surgery is retrograde ejaculation, which means that during orgasm, semen is sent back into the bladder. This is important if the patient wants to be a father. Retrograde ejaculation is less serious side effects, because infertility specialists can often recover sperm cells are extracted from the urine, then using them to fertilize an egg. If sperm can not be recovered, they can be obtained directly from the testicles surgically, and then used for artificial insemination.
When the patient is a woman, colorectal surgery (except pelvic exenteration) usually does not cause loss of sexual function. Adhesions in the abdominal cavity (scar tissue) can sometimes cause pain or discomfort during sexual intercourse. If the uterus has been removed, pregnancy is no longer possible.
Colostomy may affect the appearance of the body and sexual comfort level, both men and women. Although this fact will require some adjustments, that should not prevent - to enjoy sex life.
Surgery and other local procedures for the treatment of metastatic colorectal cancer
Surgical treatment of metastases can increase life expectancy or, depending on the degree of cure the patient's disease. If there is a small amount of secondary foci in the liver or the lungs, they may be surgically removed. Operation will depend on the size, number and localization of metastases.
In cases where it is impossible to remove cancerous lesions, conservative therapies, for example, ablation to destroy tumors in the liver can be applied. However, these methods less therapeutic potential. Various techniques.
Radio frequency ablation for the treatment of colorectal cancer liver metastases
RFA uses high-energy radio waves to destroy tumor cells. Controlling by ultrasound or CT administered in malignancy thin needle-like probe. Is passed through a high-frequency radio waves, they heat and destroy tumor cancer.
It is also referred to as percutaneous ethanol injection, when injected with a needle, controlling by means of ultrasound or CT, the concentrated alcohol into the tumor to destroy malignant cells.
This type of therapy destroys tumors by freezing it. Metal probe in place under the control of the neoplasm ultrasound probe through the probe enters the cooled gas to the infected cells. This method is the most appropriate in the framework of other ablation techniques in the treatment of malignant tumors of large size, but in some cases there is a need for a general anesthetic.
These three procedures are generally good treatment options for patients who have a contraindication to surgery.
Hepatic artery embolization
Another technique that is used to treat tumors with contraindications for surgical removal. Its goal - to reduce the blood flow in the hepatic artery, which supplies most of the cancer cells in the liver. Embolization is performed by injecting materials that block a vessel. The main part of the healthy cells are not affected, because the blood is supplied to them from the portal vein.
In carrying out this procedure, the doctor inserts a catheter into an artery at the inner part of the thigh and maintains it to the liver. Typically, contrast medium is used, which allows to control the path of the catheter via angiography. Once he reaches the place in the artery introduced fine particles to lock into place.
However, embolization impairs blood flow to healthy liver tissue. This can be dangerous to patients with diseases such as hepatitis and cirrhosis when organ function is already reduced.