Economical Node Removal
Metastases of colorectal cancer are the main indication: their complete removal gives a 5-year survival rate of 30–50%, and atypical resections allow the removal of several nodes from different parts, preserving the volume of the organ (important for possible repeated resections). Technique: intraoperative ultrasound for mapping, separation of the parenchyma with an ultrasonic dissector with clipping of vessels, 1 cm margin. Blood loss is minimized with the Pringle maneuver as necessary. Histology of the margin confirms radicality; protocol chemotherapy; the liver restores its volume within months.
Indications
- stomach cancer - gastrectomy/resection with lymph node dissection D2;
- tumors of the colon and rectum with complications - resection with colostomy (Hartmann operation);
- metastases and primary liver tumors - atypical resections;
- adhesive process involving the intestine in tumors - resection with restoration.
Oncological standards
Radicality in abdominal oncology surgery is determined by the margins of resection and lymph node dissection: for gastric cancer - D2 (removal of 1st and 2nd order nodes), for colorectal cancer - resection with mesentery (CME/TME). Complicated tumors (obstruction, perforation) are operated on in stages: first, eliminating the threat with a colostomy, then restoring continuity. Hepatic metastases of colorectal cancer are resected with a good prognosis if completely removed. Each case goes through a consultation; perioperative chemotherapy is planned according to protocols.
