1 / 41

Advanced Treatments in GI Disorders

Advanced Treatments in GI Disorders . Augustine J Lee, MD, FACS, FASCRS Colon and Rectal Surgery Fort Worth, Texas March 26,2011. Financial Disclosures. None. Goals of presentation. Multidisciplinary approach Advanced treatment options Standards of Care Optimal outcome Quality of Life

starr
Download Presentation

Advanced Treatments in GI Disorders

An Image/Link below is provided (as is) to download presentation Download Policy: Content on the Website is provided to you AS IS for your information and personal use and may not be sold / licensed / shared on other websites without getting consent from its author. Content is provided to you AS IS for your information and personal use only. Download presentation by click this link. While downloading, if for some reason you are not able to download a presentation, the publisher may have deleted the file from their server. During download, if you can't get a presentation, the file might be deleted by the publisher.

E N D

Presentation Transcript

  1. Advanced Treatments in GI Disorders Augustine J Lee, MD, FACS, FASCRS Colon and Rectal Surgery Fort Worth, Texas March 26,2011

  2. Financial Disclosures • None

  3. Goals of presentation • Multidisciplinary approach • Advanced treatment options • Standards of Care • Optimal outcome • Quality of Life • Use of Technology

  4. Case Presentation • Mr C.T. 55 year old man • Medical problems • Diabetes • High Cholesterol • Previous aortic valve replacement surgery • Financial auditor • Married, lives with wife

  5. Case Presentation • Presented to HSW on June 2010 with these problems: • 3 weeks of bloating, constipation, anemia • Off and on rectal bleeding 8 years ago • Refused colonoscopy

  6. Case Presentation • Physical Exam • No, HR 115, BP 160/80 • Appearing very uncomfortable • Markedly distended abdomen • Not tender

  7. Case Presentation • Patient initially evaluated by gastroenterology team • Colonoscopy revealed mass in rectum with complete blockage • Biopsy proven cancer of the mid rectum

  8. http://www.webmd.com/digestive-disorders/picture-of-the-colonhttp://www.webmd.com/digestive-disorders/picture-of-the-colon

  9. Case Presentation

  10. Case Presentation • Large Intestinal Obstruction is surgical emergency • Decompress obstruction • Increased wall tension • Gangrene and perforation • Colostomy most common and safest procedure

  11. Case Presentation • Colonic Stent • Alternative to emergency surgery and colostomy • Specialized technique • Interventional therapy

  12. Case Presentation • Indications and Goals for Colonic Stents here…

  13. Case Presentation

  14. Case Presentation

  15. Case Presentation • Over three days, Mr. CT began to improve • Bowel movements • Relief of pain and distention • Began to eat • Able to go home • Two weeks to recover

  16. Step two • What to do with cancer? • How advanced is it? • Is it curable? • What is the best treatment possible?

  17. Staging Colorectal cancer • Depends on 3 Things • Depth of Tumor • Involvement of Lymph Nodes • Distant Metastasis

  18. Case Presentation

  19. Case Presentation

  20. Distant sites for Metastasis • Liver • Lung • Brain • Bone

  21. Case Presentation • Staging for Mr. C.T. • CT scan • Liver – no evidence of mets • Lung - pneumonia, no evidence of mets • Enlarged lymph nodes visible • CEA level – 2.6

  22. Case Presentation • Advanced Rectal Cancer • Presenting with Obstruction • Curable vs non-curable • “Neoadjuvant Therapy” • To Help or Prepare • Shrink and Downstage Tumor

  23. Case Presentation • Oncology consultation • Radiation oncology • 5 weeks of one day weekly delivery of radiation • Chemotherapy • To help “sensitize tumor cells” • Makes radiation more effective

  24. Case Presentation • 8 weeks after treatment stent fell out after BM one day • Patient no longer feeling full, or crampy, bowel movements near normal • Post neoadjuvantchemoradiation MRI

  25. Case Presentation • Curative effort • Margins free of cancer • Sharp Total Mesorectal Surgery • Professor RJ Heald

  26. TME “There is increasing evidence in the medical literature throughout the world that colorectal cancer is the most technique dependent of all the major malignancies. There is more difference in outcome in terms of cure, the number of permanent colostomies necessary, and in various other disabilities including impaired sexual function, than in any other cancer. The technique of total mesorectal excision (TME) for rectal cancer was developed by Professor Bill Heald in the early 1980s, and Basingstoke became the natural teaching centre for this precise surgical technique. The first Basingstoke Rectal Cancer Symposium was held in 1996 and is now an annual event, held during the last week of September.”

  27. Pelvic Nerves

  28. Sharp Excision • Mesorectal Envelope

  29. Case Presentation

  30. Professor Heald’s Open TME Demonstration

  31. Robotic Surgery • Enhanced visualization • Precision cautery, retraction • Minimally invasive method of precision surgery • Facilitates Nerve Sparing

  32. Posterior dissection

  33. Anterior dissection

  34. Lateral dissection

  35. Conclusion • Goals of advanced therapies in GI cancers • Increase chances of cure whenever possible • Improve quality of life after treatment • Minimally invasive techniques • Precision surgery • Preserve normal anatomic and physiologic function

More Related