Surgical treatment of Cancer of Rectum
The radiotherapy and chemotherapy are sometimes used in complement and preparation of the Surgery
Cancer colorectal requires an intervention of resection (withdrawal of the tumour) in almost all the cases, for a complete cure.
The standardized surgical technique contributed to improve the rate of conservation of the anus (95%) and to reduce the rate of local repetition and the sexual surgical after-effects to turbid type of ejaculation and impotence.
The intervention consists in releasing the left colonist and removing the rectum with the tumour and the ganglia of vicinity. The released left colonist is used to restore (95% of the cases) digestive continuity by making an anastomosis colo – rectal without tension (joining of the left colonist on the rectum).
This technique is the former resection of the rectum with ablation of the mésorectum which we carry out principle by laparoscopy.
The mésorectum is a greasy fabric which surrounds the rectum and contains ganglia. It is delimited by a aponévrose, the fascia recti.
It is very clearly proven that the complete ablation of mésorectum (TME), with a fascia recti not broken decreases the risk of local relapse. The quality of the surgical gesture depends on the experiment of the surgeon in cancerology and laparoscopy.
Risk of Stomie after former resection of the rectum
Thanks to technical progress, less than 5% of all the operated patients of resection of cancer colorectal need an amputation abdomino-périnéale with installation of final colostomy.
When it is not possible to preserve the anal sphincter, the surgical gesture understands a exérèse of the rectum, anus and of sound sphincter (it is the amputation périnéale) and poses it of a final colostomy (intervention of Miles).
A stomy is the meeting of a segment of the intestine (colonist >> colostomy; iléon >> ileostomy) with the skin of the abdomen laterally to the umbilical point (left or on the right). The opening of the stomy constitutes the artificial anus.
It allows the collection in a pocket of the faeces of which the evacuation any more is not controlled by the sphincter of the natural anus.
The stomy associated with a resection with cancer with the rectum is temporary: it is generally about a ileostomy.
It will be then closed, after having checked by radiological control the good cicatrization of the digestive joining (opacifying without escapes on the level of anastomosis colorectale).
The closing of the stomy by local access is classically carried out 6 weeks after the resection of the rectum. An early closing with J 10, during the same hospitalization, is sometimes possible. Nevertheless, this stomy can be final if it is carried out within the framework of a cancer very low located and not allowing to save the sphincter (final colostomy associated with amputation of the rectum).