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CARCINOMA COLON
RECTUM
SURGICAL ASPECT
PAULUS SOETAMTO
WIBOWO
Australia
New Zealand
Japan
Hongkong
Singapore
China
Rep.of Korea
Malaysia
Phillipine
Vietnam
Papua New Guinea
MALES
FEMALES
ASR
65.66
74.13
60.51
60.40
44.65
29.34
15.11
40.70
22.01
29.71
15.08
Indonesia
22.000-30.000
NEW CRC/YEAR
SUMANTI WARTATMO
PHILLIPPI SUDJATMIKO
MANADO JOGJAKARTA JAKARTA SURABAYA
1990-1995
1994-1996 1991-1993
Caecum
C.Asc
C.Transv
C.Desc
Sigmoid
Rectum
3 (3.3)
9 (9.8)
5 (5.4)
10 (10.9)
15 (16.3)
50 (54.2)
TOTAL
92
3 (1.5)
8 (4.1)
41 (20.9)
144 (73.5)
196
29 (25)
11 (10)
17 (15)
23 (20)
34 (30)
8 (6.1)
13 (9.9)
3 (3.0)
12 (9.2)
12 (9.2)
53 (52.6)
114
131
SUDARSA
DENPASAR
1990-1995
5 (4.0)
8 (6.5)
5 (4.0)
6 (15.3)
19 (15.3)
81 (65.3)
124
RECURRENT
80 % WITHIN 2 YEARS
HEPATIC 50 %
LUNG
20 %
LOCAL
33 %
PERITONEAL SEEDING 22 %
STATISTIC USA 2001 AMERICAN CANCER SOCIETY
Colon Resection
Total
resection
Negative
proximal
distal
radial
Extended lymphadenectomy
Reanastomosis end to end
COLON RESECTION
COLON RESECTION
VENOUS DRAINAGE
COLON RESECTION
COLON RESECTION
PREOPERATIVE
NUTRITIONAL STATUS
BOWEL STERILIZATION
COLON RESECTION
RIGHT COLON :
DUODENUM
RIGHT URETER
RIGHT GONAD VESEL
LEFT COLON : LEFT URETER
LEFT GONAD VESEL
SPLEEN
BOWEL OBSTRUCTION
LEFT COLON
IN
DOUBT
HARTMANN /
ILEOSTOMY
TME
Bladder
Penis
Prostate
Sacrum
Anus
Rectum
Coccyx
"coning in"
Cilindrical resection
CARCINOMA RECTUM
PREVENTION OF
LOCAL RECCURENCE
QUALITY OF LIFE
(SOCIAL LIFE)
MULTIMODALITY
COMBINED THERAPY
(MCT)
TOTAL MESORECTAL
EXCISION
(TME)
SPHINCTER SAVING
PROCEDURE
(STAPLES)
CARCINOMA RECTUM
TOTAL MESORECTAL EXCISION
1982 HEALD (GREAT BRITAIN)
METASTASE LATERAL (RADIAL) > DISTAL
TME
2 CM DISTAL STUMP
SPHINCTER SAVING
(FROZEN SECTION)
TME
Local recurrence
12%
6%
Overall survival
60%
73%
4-6
wks
3-6 wks
CHEMORADIATION
5FU + LEUCOVORIN
4000cGY
DOWN STAGING
RESECTABILITY
LOCAL RECURRENCE
SURGERY
CHEMORADIATION
PREOPERATIVE ASSESSMENT
OF RECTAL CANCER
ANTERIOR RESECTION
> 15 CM
10-15
CM
PARTIAL TME
CLINICAL T1 N0 M0
CLINICAL T2 N0 M0
1-10 CM
CLINICAL T3 N any M0
CLINICAL T4 N any M0
<1 CM
LOCAL EXCISION
TME
PRE-OP CHEMORADIATION
CHEMORADIATION + TME
POST-OP CHEMORADIATION
PRE-OP CHEMORADIATION +
APR
APR
CONCLUSION
SURGICAL AUDIT
TO IMPROVE SURVIVAL