Colorectal Cancer or Rectal Cancer is cancer of the lowest part of the large bowel immediately above the anus.
Rectal cancer is best treated in a multimodal manner with many disciplines of medicine involved including the surgeon, chemotherapy doctor and radiation doctor. Some patients require radiation and chemotherapy prior to the surgery, others require surgery alone and others require chemotherapy after the surgery. There are various investigations that help Dr Allison best plan your treatment.
Preoperative investigations may include colonoscopy, CT scan, MRI scan and endorectal ultrasound. These will help Dr Allison tailor your treatment to your needs.
Surgery to remove the rectum is called a Low Anterior Resection.
Low anterior resection can be performed by an open laparoscopic (key-hole) or robotic approach. The decision about which is best for you will be decided by Dr Allison to optimise your cure from cancer.
A 5mm port (tube) is placed into the abdominal cavity. From there, 4 small incisions are made and 4 robot ports are inserted. Instruments and a camera are inserted.
The rectum is mobilised and the segment with the cancer is removed along with lymph nodes through one of the port sites. The bowel is joined together, and the anastomosis (join) is tested to ensure it is intact.
There are many structures that are identified and preserved including the ureters which are long tubes that carry the urine from the kidney to the bladder and hypogastric nerves that are required for ejaculation and erection in males.
Sometimes a loop ileostomy is required. This is a temporary stoma which diverts the faeces from the anastomosis site while the anastomosis heals. This stoma is removed at a second operation after the anastomosis has healed. This is more commonly required for very low anastomoses.
The advantage of the robot is more precise dissection with reduced risk of injuring other structures. The robot also has “firefly” which the use of a luminescent dye which can assess the blood supply to the bowel and further reduce the risk of an anastomotic leak (the join does not heal well).