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Advances in Colorectal Cancer Surgery

Mazin F. Al-Kasspooles, MD, Surgical Oncologist
John H. Ashcraft, DO, Colorectal Surgeon

More than 143,000 people will be diagnosed with colorectal cancer in 2012, and more than a third of them will not survive. Five-year survival rates can be as high as 75 percent when the cancer is found and treated early, but they drop dramatically at later stages. Surgery is the most important modality in achieving a cure.

Minimally invasive options lower risk, shorten recovery

Many early-stage colorectal cancers are candidates for laparoscopic-assisted surgery – some using robotics. This option often is ideal for early-stage colon cancer, rectal cancer and diverticulitis. Laparoscopic surgery in general carries fewer risks than open surgery and can lessen pain, speed recovery and shorten hospitalization. Data show essentially equivalent results with laparoscopic and open surgery for both cancer and benign GI disease. Minimally invasive techniques have been shown to be oncologically sound specifically for lymph node retrieval, locoregional recurrence and survival.

Additional advantages of the minimally invasive approach include:

  • Lower incidence of ileus
  • Quicker resumption of oral diet
  • Fewer wound infections
  • Less scarring, for better cosmetic results
  • Possibly less short-term mortality

Laparoscopic contraindications

Many patients are expressing interest in laparoscopic and robotic procedures, but some are not good candidates. Physicians can set reasonable expectations by helping patients understand the conditions that may preclude these options.

  • Multiple abdominal surgeries and adhesions
  • Advanced disease
  • Morbid obesity
  • Severe respiratory issues

Robotic surgery experience critical 

The University of Kansas Hospital is one of few in the area with established experience in robotic surgery for GI cancer, pancreatic cancer, larger hiatal hernias and rectal tumors. The hospital has been performing robotic surgery for colon and rectal cancer since 2005.The da Vinci® Surgical System gives the surgeon much better visualization and dexterity for more accurate results. It provides a three-dimensional view of the surgical field and magnification of up to 12 times. The robotic arm also offers superior flexibility and maneuverability, improving the surgeon’s control and precision.

SILS cosmetically appealing

Some patients, specifically those with early-stage colon cancer, are candidates for single-incision laparoscopic surgery through the umbilicus. This technique is available to patients of average size and those whose cancer is confined to the colon – not requiring resection of the liver or other organs. We also can use this single-port access for robotic cholecystectomy. When SILS is the appropriate option, patients especially appreciate the cosmetic benefits of this approach.

TEMS provides minimally invasive option for rectal adenomas

Patients with large, early-stage rectal adenocarcinomas and those with rectal polyps that cannot be removed endoscopically may benefit from transanal endoscopic microsurgery. This minimally invasive technique – ideal for patients who are not fit for surgery – carries a lower risk of complications and provides for a much faster recovery. Although it has been available for some time, The University of Kansas Hospital is one of few in the region with access to the equipment and a large enough volume of cases to develop proficiency.

Multidisciplinary approach provides expanded capabilities

Each GI cancer patient receives the attention of our site-specific tumor board, including specialists from medical, radiation and surgical oncology; gastroenterology; neuroradiology; endocrinology; pathology; and genetic counseling.

Additional unique capabilities

  • Simultaneous excision of colorectal  adenomas and liver metastases
  • Ablation therapy
  • Tackling advanced colorectal cancer with complex pelvic involvement – both primary and recurrent – with a team that includes urology and gynecology specialists
  • Providing cytoreductive surgery and hyperthermic intraperitoneal chemotherapy, or HIPEC, for patients who have appendiceal cancer, pseudomyxoma peritonei and those with recurrent colorectal cancer involving the peritoneal surfaces. 
In the future, we expect to offer even more elaborate and less invasive transanal endoscopic interventions, as well.

Clinical trials available

We are involved in multiple GI cancer clinical trials. In fact, several GI cancer treatment breakthroughs now considered standard practice were developed from clinical trials at The University of Kansas Hospital. We are currently recruiting for two studies involving chemotherapeutic and biological agents treating colorectal cancers. For more information on these trials, visit kucancercenter.org/cancer-clinical-trials.

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