Colon and rectal cancer is the third most common malignancy worldwide, with more than 750,000 people each year being diagnosed with this form of cancer. The good thing is that the cure rates are high, since the specific neoplasm has been found in the initial stages. On the other hand, unfortunately, it has been observed that in recent years, rectal cancer appears more and more at younger ages compared to the past.
With this data, the American College of Gastroenterologists has issued a guideline for the general population, without family history or symptoms, to start regular colon and rectal screening starting at age 45.

What is it caused by?

Although the causes of colon cancer are not fully known, international studies have shown that certain risk factors increase the chances of its occurrence, such as poor diet, high consumption of alcohol and red meat, polyps, individual and family history, but also obesity.

What are the ways to deal with it?

The treatment of rectal cancer – the final part of the colon with a length of 15 cm – is different from the rest of the colon. This happens because the rectum is located low in the pelvis and has an extraperitoneal position, that is, it is an organ outside the peritoneal cavity. Consequently, patients with locally advanced stage disease are offered preoperative chemotherapy as well as radiation. For definitive treatment, surgery is almost always necessary, with the aim of prolonging patients’ life expectancy, trying to avoid local recurrence and improving patients’ quality of life, such as avoiding a permanent stoma and keeping the urology intact. and sexual function of the patients after surgery” points out Mr. Christos Liakos Director Surgeon General at Metropolitan Hospital.

How is the operation performed?

The operation performed when rectal cancer is deemed resectable is the low anterior resection, i.e. the removal of the diseased part of the rectum together with the entire perirectal fat with the lymph nodes and then the restoration of the continuity of the digestive tract, the reunification of the intestine and the its anastomosis.
“The perception of the specialized Colon Surgery Unit is more human-centered, with the aim and purpose of maintaining the best possible level of quality of life after the operation, by performing “sphincter-saving” operations. Such surgeries aim to restore intestinal continuity and preserve the sphincter mechanism, without compromising the oncological outcome. With this approach and perception, the abdominoperineal resection, which was the “golden standard”, which includes the complete removal of the anal lumen with the surrounding sphincter and, finally, the creation of a permanent colostomy, is performed less and less by the surgeons of Unit of the Metropolitan, who prefer the technically more difficult, but with a more satisfactory result for the patients, “very low” excisions or even local excisions, using all the means of minimally invasive surgery (laparoscopic, robotic, rectal surgery).
Minimally invasive techniques have shown significant benefits in the treatment of colon cancer. However, rectal surgery is technically more demanding with a more difficult learning curve. The rectal approach to resection of the mesorectum was introduced to complement conventional surgery so that any technical difficulties associated with distal (peripheral) rectal anatomy could be overcome.
Since the introduction of this new approach, interest in transanal resection of the mesorectum has increased, and it appears that the benefits are greatest in patients with mid- and distal (low) rectal cancer, where anatomic and pathologic factors present the greater challenges. This approach is safe and feasible, with an acceptable morbidity profile. Oncological and functional data appear comparable to conventional approaches, but most results come from small studies with short-term endpoints,” explains the expert.

Is it possible to deal with robotic technology?

Robotic surgery, when available, can potentially overcome the difficulty of the lower third of the rectum with a shorter learning curve compared to the rectal approach, but at a higher cost.
“The application of robotic technology to TaTME (rTaTME) appears to be the next logical step in the evolution of minimally invasive surgery, allowing the benefits of improved freedom of movement, platform stability and 3D vision, while adhering to the principles of NOTES ( Single hole surgeries). The distal third of the rectum is a challenge even in very experienced surgical hands and could be difficult to reach transabdominally, sometimes at the cost of an unavoidable deviation from the principles of oncological radicality and nerve preservation,” notes the surgeon. And it continues:
“TaTME is considered by some to be the culmination of 30 years of advances in colon cancer surgery. Even Bill Heald, the mastermind behind TME, has embraced and supported this revolutionary approach, finding gas insufflation and rectal vision to be of great help in difficult steps in the lower third of the rectum, especially at the anterior level in the male pelvis. , resulting in better identification and preservation of nerves, a finding very important for the future of colon surgery. With similar postoperative complications compared to standard laparoscopic or open TME, which show remarkable oncological outcomes, the available literature suggests that TaTME is safe and feasible to bring excellent results in the hands of appropriately trained surgeons. TaTME should be considered among the gold standard approaches to be offered to selected high-risk rectal cancer patients.”
“This surgical technique is now performed at the Metropolitan Hospital, by its experienced and specialized team in the Colon Surgery Unit, which provides comprehensive and individualized treatment for all benign and malignant surgical diseases of the digestive system, with a special emphasis on diseases of the colon intestine”, concludes Mr. Liakos.