Colorectal cancer laparoscopic surgery

By Cristiano Antonino On Mar 29, 2023

Colorectal cancer is the third most common cancer worldwide, after lung and breast cancer

It is important to emphasise, however, a positive fact: thanks to early diagnosis and improved treatments, the cure rate from colorectal cancer is now high, at around 60% of cases, and mortality, in recent years, has fallen sharply.

What colorectal cancer is and how widespread it is

By colorectal neoplasms we mean all neoformations that result from an abnormal proliferation of cells from the mucous membrane of the large intestine that runs from the ileocecal valve to the anus.

The symptoms

Typical symptoms and signs can sometimes be nuanced, but generally consist of:

blood loss in the faeces
abdominal pain;
decreased haemoglobin and iron levels in the blood and/or changes in bowel function.

However, sometimes the tumour may manifest itself more acutely with a picture of true intestinal obstruction (vomiting and abdominal distension).

Patients, who already have a family history of colorectal cancer or suffer from genetic syndromes that determine a predisposition to it, deserve more attention and should be subjected to earlier and tighter prevention programmes.

Treatment of colorectal cancer

The treatment of colorectal cancer is variable, depending on the stage of the tumour at diagnosis: it ranges from traditional or laparoscopic surgery to its combination with chemotherapy or radiotherapy.

During the operation, the surgeon will proceed to remove the affected part of the intestinal tract, either by so-called ‘hemicolectomy’ – or surgical removal of one half of the colon – right or left, or by resection of the rectum, either anteriorly or via the abdominoperineal route.

At the same time as the removal of the tract in which the neoplasm is located, it will be decided whether to also remove the healthy margins and associated lymph nodes in order to restore the functionality and continuity of the digestive connection.

Sometimes, generally for tumours closer to the anus, it is also indicated to perform an ostomy, i.e. a diversion of the intestinal contents to the outside through an opening in the abdomen (in most cases temporary and currently only in a very small percentage of operations definitive) in order to achieve complete oncological radicality.

The laparoscopic surgical approach to colorectal cancer

In recent decades, the laparoscopic surgical approach has progressively taken the place of the conventional one.

Compared to traditional surgery, which involved an abdominal incision of varying size from case to case, this method allows the same operation to be performed through incisions of just a few millimetres, made after ‘inflating the abdomen’ with special gas, into which a camera and the surgical instruments needed to perform the operation are inserted.

Despite the need for adequate training on the part of the surgeon, the benefits for patients are significant: data from the literature, as well as the team’s decades of clinical experience, have shown a clear benefit in both hospitalisation time and postoperative complications, with the same oncological results.

The laparoscopic technique, to date, is the preferred approach, but the final decision must always be taken in agreement with the anaesthetist team since certain cardiological pathologies are an absolute contraindication.

Currently, of the 200 colorectal resections performed each year by the Gastroenterological Surgery team, 80% are successfully completed by means of a minimally invasive laparoscopic approach.

Convalescence after laparoscopy

If no complications occur, discharge after the operation is expected after 5 days on average, followed by an outpatient check-up about 1 week later and another one after 1 month.

Although with a certain variability linked to the different clinical cases, laparoscopy allows a rapid recovery of daily activities at home, guaranteeing a good quality of life during the convalescence period at home and better recovery times at work, in social and emotional terms.

ERAS protocols for rapid post-operative recovery

Patients, before and after surgery, follow ERAS (Enhanced Recovery After Surgery) protocols.

These are standardised and internationally recognised peri-operative management protocols that facilitate rapid recovery after major surgery and improve outcomes.

This care pathway foresees the active involvement of the patient through certain measures and expedients that are adopted in the pre- and post-operative phases: in this sense, after being adequately prepared for surgery, the patient is also supported and followed in the post-operative phase by the medical team and by a set of diversified professional figures, but specialised in colorectal pathology, such as nurse navigators, physiotherapists, nurses and nutritionists.

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