Synchronous colorectal cancer: double
colon resection, case presentation in
patient with three tumours. Discussion
about diagnosis and operative
management.
Cafferati M, Grammatico V, Ghersi T, Cumbo P.
Struttura Complessa di Chirurgia
Direttore Dott. Pietro Cumbo
Ospedale di Carmagnola (Torino)
Patient:
- 82 years old patient, healthy for age
- One episode of enterorragy in ASA treatment
Colonoscopy:
1° Substenosis at 20 cm
Adenoca
2° Large polyp
Adenoma high grade dysplasia
3° Right colon polyp Adenoma low grade dysplasia
Normal US and CT scan
Surgery:
left hemicolectomy + right hemicolectomy
with ileum-trasversum anastomosis + transversum-rectal
anastomosis
Histology:
pT2, pN0
well differentiated multiple adenocarcinoma
Real synchronous tumours are at least at 2 cm from the
main lesion
INCIDENCE OF SYNCHRONOUS CANCERS
OF ALL CRC:
-Before colonoscopy: 1 – 3%
-Until 2000: great variability, between 2 and 10%
-Last 10 years: 2 – 4,2%
PATIENTS WITH MORE THAN
TWO SYNCHRONOUS TUMOURS
-Eu, Seow-Choen 876 cases of CRC: 0,56%
-usually between 0,3 and 0,6%
-our series: 0,25% of 390 CRC in the last 10 y.
PREOPERATIVE DIAGNOSIS
- Colonoscopy: 30 - 66%
done for stenosis
of the main tumour
-not obstructing stenosis: barium enema
-if obstruction: intraoperative colonoscopy
-virtual colonoscopy may provide better results
Surgical Treatment
- Most of Authors: subtotal
colectomy with ileorectal anastomosis
- but the main indication to subtotal colectomy
is the presence of multiple adenomas
- Double colon resection, with intensive
endoscopic follow up.
OSPEDALE DI CARMAGNOLA
Thank you!