Colorectal cancer is one of the most common gastrointestinal malignant tumors, and its incidence rate in the region has been increasing at an annual rate of more than 8% in recent years. Patients who get early treatment have a better prognosis, but those who come to the clinic after symptoms appear are mostly in the middle or late stage, which is difficult to get radical treatment and the risk of surgery is also great. In this live surgery, we will recreate the whole process of saving two patients with severe colorectal tumor to you. Although the old man usually suffers from hypertension, coronary heart disease, emphysema and other chronic diseases, he has never had any problems with his stomach and intestines, and the persistent and severe abdominal pain made the strong master Zhang unable to bear it anymore. After being admitted to the general surgery department, the doctor found that the patient had high blood pressure, a temperature of 38.5°C, a very poor spirit, muscle tension throughout the abdomen, obvious pressure pain, and very weak intestinal sounds. Along with treatment such as blood pressure lowering and fluid replacement, ECG, chest X-ray and abdominal CT examination were immediately performed. Case 2, last October, 62-year-old Master Liu had intermittent abdominal pain and discomfort for three months, initially did not take it seriously, then felt the abdominal pain gradually intensive, the body also lost some weight, to the hospital for colonoscopy found that the ascending colon and sigmoid colon each have a tumor about 3-4cm in diameter, the disease examination suggests that it is malignant. The family was so anxious that they found the director of general surgery Xie Song. In case one, Director Xie understood the condition of Master Zhang and carefully studied the abdominal CT film, and found that there was an occupying lesion in the ascending colon, which was generally considered to be a malignant tumor in the colon, and combined with the clinical manifestations of the abdomen, it was likely that the cancer had broken down and perforated, and should be operated immediately. However, an old man in his eighties with serious cardiopulmonary disorders could not be over-prepared for a major emergency surgery, and the danger was imaginable. Director Xie Song did not hesitate and quickly developed a surgical plan. Case 2, after further examination and accurate localization of the tumor, Director Xie decided to perform both right hemicolectomy and sigmoid resection for Grandpa Liu, which ensured complete eradication of the tumor while preserving part of the function of the large intestine. Because of the large scope of the operation (equivalent to two major operations) and the need for two intestinal anastomoses, there were certain risks during and after the operation. Case 1, Director Xie Song performed emergency surgery for Grandpa Zhang and found that there was an 8cm diameter cancer in the ascending colon, blocking the intestinal lumen and causing perforation of the posterior wall, which was extremely consistent with the preoperative judgment. According to the treatment standard, when emergency surgery is encountered, there are three surgical options according to the basic condition of the patient and the technical level of the surgeon: Option 1, temporary colostomy (artificial anus) without tumor resection, and then second stage tumor resection after the condition is stabilized; Option 2, temporary colostomy with tumor resection, and then intestinal anastomosis after the condition is stabilized; Option 3, first stage tumor resection with intestinal anastomosis. The third option is to remove the tumor in one stage and perform intestinal anastomosis. The first approach involved the least risk to the surgeon, but the patient had to undergo an enterostomy and two surgeries, while the third option was the opposite. After urgent consultation with the anesthesiologist and the family, Director Xie decided to choose the third option, which was the most difficult. Director Xie performed a radical resection of the tumor (right hemicolectomy) and regional lymph node dissection, and anastomosed the severed end of the intestinal tube. The surgery went very well. Case 2, three days after admission, Grandpa Liu successfully underwent right hemicolectomy and sigmoid resection, with most of the large intestine and part of the small intestine removed, and two intestinal anastomoses (between small intestine and colon, and between colon and rectum), with minimal bleeding and no blood transfusion. Director Xie Song said that colorectal cancer occupies the second place of gastrointestinal malignant tumors in China, and the incidence has increased from 10/100,000 in the 1960s to 36.1/100,000 at present, and the number of new cases is about 130,000 to 160,000 every year. The growth rate of colorectal cancer in this region is much higher than that in some cities or rural areas in China, and the growth rate of colorectal cancer in women is faster than that in men, and the incidence of colorectal cancer in rural areas is significantly higher than that in urban areas. This is related to the increasingly “fine” diet of residents, long-term consumption of “three high” and low-fiber foods, especially the improvement of living standards and lifestyle changes of rural residents. When the tumor grows to a certain extent, blood in stool can appear. With the increase of cancer and secondary lesions, symptoms will appear, such as abdominal pain, bloating, increased stool, abdominal mass, intestinal obstruction, anemia and wasting. Patients who have developed symptoms clinically often have very serious local lesions or even advanced stages. The effect of early treatment of colorectal cancer is far better than other gastrointestinal malignancies, but often the best opportunity to remove the tumor radically is missed due to untimely detection. There are many cases like Mr. Zhang who did not come to the hospital until intestinal obstruction and intestinal perforation occurred. After the patient was sent to the hospital, doctors had difficulties from the beginning of diagnosis because the most direct way to diagnose colorectal tumor is colonoscopy, and often these patients cannot clean their intestines sufficiently and their condition is critical, making it difficult to make a clear diagnosis before surgery. Firstly, most of the patients are old and in poor general condition, which makes surgery and anesthesia very dangerous; secondly, the acute inflammation is heavy and the abdomen is very complicated, which makes the judgment and surgery more difficult; finally, the choice of surgery plan is also a test of blood and fire for surgeons. If the first relatively safe option is chosen, it can reduce the temporary life risk, but it often requires secondary surgery and delays the earliest time to cure the tumor, in addition, the enterostomy (artificial anus) will also cause great harm to the patient’s body and heart; if a radical resection option is chosen, enterostomy and secondary surgery can be avoided, but it greatly increases the risk of intraoperative and postoperative recovery, and once things go against the wishes The consequences are unimaginable. Often, only a physician with both excellent medical skills and a strong will can withstand the test and turn the patient into a survivor. The mortality rate of patients over 80 years old who undergo surgery is high, especially in emergency surgery, and any mistake in surgery, anesthesia and post-operative response can be a total loss. Director Xie said, as a surgeon, fighting with death sometimes depends not only on technology, but also on love and endurance, just like walking on a tightrope on the abyss, any failure can not reach the other side! It is extremely rare that malignant tumors are found in two or more different parts of the large intestine at the same time, and the distance between them is more than 10cm, which is called simultaneous multi-origin carcinoma. How to find a balance between eradicating the tumor and reducing trauma and complications is a difficult problem in this type of surgery. After accurate preoperative positioning and correct surgical plan design, the treatment was very successful. Post-operative recovery: Master Liu recovered smoothly after the surgery and safely passed the “hurdles” such as intestinal bleeding, intestinal leakage, wound infection and anastomotic stenosis, etc. He gradually transitioned to a normal diet after a week and was soon transferred to chemotherapy. After the operation, Master Zhang had some twists and turns due to heart and lung disorders, but he was finally discharged from the hospital.