HTHSCI 1DT3 Lecture 15: anatomy sur-57-64
26 Dec 2020
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Mri best for rectal ca and liver mets. T4: through the serosa to adjacent organs. Pre-operative bowel prep (except r sided lesions) Kleen prep (macrogol: osmotic laxative) the day before and phosphate enema in the am. Excision depends on lymphatic drainage which follows arterial supply. Mobility of bowel and blood supply at cut ends is also important. Laparoscopic approach is the standard of care. Neo-adjuvant radiotherapy may be used to local recurrence and 5ys. Anterior resection: tumour 4-5cm from anal verge. + total mesorectal excision for tumours of the middle and lower third. Sigmoid: high anterior resection or sigmoid colectomy. Hepatic resection: if single lobe mets only. Stenting: palliation or bridge to surgery in obstruction. Adjuvant 5-fu for dukes" c mortality by 25% i. e. ln +ve pts. Home fob testing every 2yrs: ~1/50 have +ve fob. Screening risk of dying from crc by 25% Piling up of goblet cells and absorptive cells.
