VII Treatment Surgery is preferred. a. Radical treatment b. Quality of survival
1. Surgery (operation) Indications: Any rectal cancer that can be resected and there is no contraindication, radical surgery should be performed as early as possible. For isolated liver metastasis, liver lobectomy or wedge resection can be performed at the same time, or cannula embolization flower therapy. Zheng Naiguo, Department of General Surgery, Guiyang Second Affiliated Hospital of Traditional Chinese Medicine
TME (total mesorectal excision) is a conceptual change in radical surgery for rectal cancer, centering on the whole removal of all nerves, blood vessels, fat and connective tissues encircling the rectum between the pelvic visceral peritoneum and the mural peritoneum [5,6].
A Non-anal preservation surgery.
Miles procedure; classical radical surgery. Indicated for: cancers <7 cm from the anus. Failure of anus-preserving surgery and recurrence. Advantages: complete, radical and widely used. Disadvantages: large trauma, permanent artificial anus. The quality of survival is not satisfactory. Some people use the femoralis or gluteus maximus instead of the sphincter and do in situ anal surgery with intestinal sleeve, but the results are not satisfactory.
Enterostomy: permanent – temporary, abridged – non abridged stoma.
Generally permanent stoma, is actively researching abstinence to achieve less and no use of anal pouch.
Permanent stoma: KOCK bags are commonly used abroad to prevent ileal contents from flowing out, without wearing a fecal bag. Because the ileal outlet has a live flap.
Section manufacturing stoma: Indications: not spread, normal defecation, willing to take the risk of reoperation. There are 4 types: 1. devices such as colostomy plugs: composed of substrate and plugs, plugs with carbon filters, filter gas to make it odorless, plugs made of polyurethane foam, insert artificial mouth, foam expansion to close the intestinal cavity; 2. magnetic ring: not commonly used, because the operation requires special care, the long-term effect is not good; 3. muscle graft: take the smooth muscle of the colon to do artificial anal sphincter, the effect is 80%; domestic people use abdominal Rectus muscle, thin femoral muscle or gluteal muscle or the proximal cut end of the colon itself is fixed at the original anus, the effect is not good. 4. silicon ring and balloon can be implanted: the silicon ring is implanted in the abdominal cavity, sutured at the abdominal wall stoma, the colon is dragged out from the ring, and the balloon bolus closes the intestinal cavity, the effect needs to be evaluated. Stoma devices are developing fast. Recently new types of ostomy bags have been introduced. Such as extra-soft protective rubber ring with rubber sheet ostomy bag can reduce the pain caused by the ostomy bag. Recently, some countries have developed intelligent ostomy bags.
B. Anal preservation surgery According to Miles surgical clearance, colon and rectum or anal canal anastomosis.
Advantages: little damage, preservation of the anus, satisfactory defecation function. Disadvantages: limited resection of the distal rectum of the tumor, difficulty in intrapelvic anastomosis, certain complications such as anastomotic fistula, bleeding, stricture and recurrence, and frequent stools. With the use of anastomosis, lower rectal cancer (6-7 cm from the anus) can be anus-preserving.
**Rationale for anus preservation 1. to improve the quality of survival. 2 Technical improvement, especially the anastomosis. 3 Theoretical study: it is found that cancer metastasis is mainly upward, downward rarely more than 1.0-1.5 cm, 2.5-3.0 cm from the lower edge of the tumor Excision of the rectum is sufficient, some people believe that non-free should be >3.0 cm, free >5.0 cm.
But there are arguments: A recurrence B late staging discomfort and anal preservation C too many anal canal resection, defecation disorder, data show that 80% of defecation is completely normal when the anal canal is resected. The length of 1-2.5 cm, 2 years after surgery can control defecation < 50% [6].
**Control of postoperative complications after anus preservation
1) Increased number of stools.
A. Storage pouch Flute proposes to rotate the ileocecal close to 2 cm counterclockwise 180′ between the colon and the anal canal. b. J pouch (more popular),W pouch
2) Anastomotic difficulties: “pelvic boost” (perineal push) may give the benefit of anterior resection for lower rectal cancer.
A) anterior resection (Dixon procedure): for lesions with the lower margin of cancer 10 cm from the anus and 6-7 cm from the anastomosis. The
B) Low anterior resection