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It is important that a proper family history of cancer be taken. Especially families where there are a large number of members with colorectal cancer and other families that have a large number of colorectal cancer together with other cancers especially of the urinary system and female genital tract. These two sort of families usually have several members who had the disease when they were very young, less than 40 years of age. Special consideration must be given to the surveillance of members of these two sorts of families for screening at younger ages, than would be applicable to the general population. Special families with high risk for colorectal cancer are families with HNPCC and FAP.
However if the index or first case is the only one with colorectal cancer in the family and this person is older than 50 years of age then the other members of this particular family have only the low population-at-large risk of getting colorectal cancer. Members of this family would probably require only surveillance when they have reached the age for normal population screening in any case unless there are other special reasons to screen such a family.
The mortality rate for major colorectal surgery is less than 3%. This figure however may be doubled or higher for emergency and also in palliative surgery. About one third of deaths are due to post-operative surgical complications mainly associated with infection from anastomotic leaks. Other important causes of deaths are those due to cardiac, respiratory and venous thrombo-embolic problems like pulmonary embolism. Such complications are more common in the elderly patient with coexisting medical problems.
Infective complications may occur as a result of anastomotic leaks, wound infection or intra-abdominal infections. Other sources of infection include peripheral lines and central venous lines as well as respiratory infections. lnfection is also more common In patients with diabetes and other immune-compromised patients Chest infection is more common in patients who are debilitated and immobile as well as in patients who have pre-existing chest problems like bronchiectasis, bronchitis and asthma.
A high incidence of anastomotic leaks can be lowered but no matter how much care a surgeon takes in securing a good anastomosis not all anastornotic leaks can be prevented. Operations such as ultra-low anterior resection in the best of hands are still associated with a anastomotic leak rate of around 5-10% such high risk cases hence, a temporary defunctioning anastomosis is usually made. This stoma can be closed after about a month or so.
Venous thrombosis and pulmonary embolism are also more common in patients who have been lying in bed immobile for some time as well as patients with cancer or who are on oral contraceptives.
The most important factor in deciding if the anus needs to be removed is the distance between the lower edge of the cancer and the top of the anal sphincter muscles. If there is insufficient distance to allow a clear margin for resection to secure the lowest possible recurrence rate then the anus will have to be sacrificed so that complete clearance of the cancer is possible,.
Specialist surgeons who deal with colorectal conditions should be able to preserve the anus in cases where the cancer may be as low as 3 to 5 cms from the anal verge depending on the length of the anal canal. However this decision may be influenced by the extent of spread locally, the grade of the cancer, the type of pelvic anatomy and the bulkiness of the cancer itself.
Adjuvant therapy is additional therapy that is added to the primary treatment of the colorectal cancer either before or after surgery in an effort to increase the chances of the patient being totally cured. Normally this means the addition of chemotherapy and/ or radiotherapy.
- Conventional Open Surgery Approach
Most conventional open surgeries require a long incision on the abdomen. The average hospital stay is five to seven days or longer depending on the time necessary for bowel activity to return and for the patient to tolerate taking anything by mouth.
- Laparoscopic Surgery Approach
In laparoscopic colorectal surgery, usually 3 small incisions are used for instruments and camera. The specimen is removed by slightly enlarging one of the incisions. The benefits of laparoscopic surgeries are related to less surgical trauma. The small incisions utilized in laparoscopic surgery are associated with considerably less pain and the cosmetic results are significantly better. Patients usually have quicker resumption of diet and shorter hospitalization.
Laparoscopic surgery is associated with earlier postoperative recovery. Patients who undergo laparoscopic surgery are often discharged from the hospital after 3 days and return to their usual activity much earlier than patients who undergo open surgery. Here at Seow-Choen Colorectal Centre Pte Ltd, laparoscopic surgeries are done routinely.
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I have had colorectal cancer, should all members of my family
