Surgical resections and staging of colorectal carcinoma

Surgical resections and Staging of

Colorectal carcinoma

Anatomy 1 - Arterial blood supply to the

colon

Artery of Drummond

Anatomy 2 - Venous drainage of the

colon

Anatomy 3 – Linin of the anal canal

Anatomy 4 – Arterial supply to the

rectum and anal canal

Anatomy 5 – Extend of resection for carcinoma

Cecal CCA Hepatic flexure CCA

Transverse CCA Splenic flexure CCA

Descending CCA Sigmoid CCA

Anatomy 6 – terminology of types of

colorectal resections

Proctocolectomy

• Total proctocolcetomy

• Restorative proctocolectomy (Ileal Pouch Anal Anastomosis)

• Anterior resection

– High: distal sigmoid + upper rectum, anastomosis

– Low: upper and midrectum, anastomosis

– Extended low: distal rectum, colon J-pouch, coloanal anastomosis

– Hartmann’s procedure: blind pouch, creation of mucus fistula

• Abdominoperineal resection:

– Removal of entire rectum, anal canal and anus with construction of

permanent colostomy

Anastomoses 1 - ilael J-pouch after

restorative proctocolectomy

Anastomoses 2 - Ileal S-pouch

anostomosis

Anastomoses 3

Technique of end-to-end colorectal

anostomosis

Routes of spread and natural history

• T1-2 means N1 in 5-20%

• T3-4: means N1 in >50%

• >4 +ive nodes predicts poor prognosis

• Colon: lymphatic spread follows major venous outflow

• Rectum: 2 routes

• M+: liver + lung + peritoneal

Staging 1/2

Staging 2/2

• Stage-specific therapy for colonic CA:

• Stage 0 (Tis, N0, M0)

• Stage I: The malignant polyp (T1, N0, M0)

• Stage I and II: Localized colon carcinoma

(T1-3, N0, M0)

• Stage III: Lymph node metastasis (Tany,

N1, M0)

• Stage IV: Distant metastasis (Tany, Nany, M1)

• Preoperative evaluation usually identifies IV disease.

• uTXNX in rectal cancer preoperatively

Stage-specific therapy in rectal

carcinoma