Colorectal cancer, inflammatory bowel diseases and diverticular disease: these are the topics at the centre of a Facebook stream with Professor Antonino Spinelli, Head of Colorectal Surgery at Humanitas and Professor at Humanitas University.
Colorectal cancer in Western countries represents the second neoplasm in terms of incidence and mortality; in Italy, 40,000 women are affected and 70,000 men; what are the risk factors?
“Colorectal cancer is one of the so-called big-killers, it is a neoplasm that significantly affects the population and epidemiological studies have shown that this trend is particularly linked to Western countries and therefore with a similar lifestyle to ours, and is much lower in countries with a more rural lifestyle, such as Africa and Asia. Environmental factors and dietary factors that establish a genetic background certainly play an important role.
The age most at risk is an older group (60 years), but recent studies have shown that in younger age groups – traditionally considered less at risk – the risk is increasing, with an incidence of 2% per year, a growth that is a wake-up call for everyone.
Particularly at risk are those who have a relative in the family who has developed a cancer of the intestine in the past and those who have conditions predisposing to the development of a tumor, such as inflammatory chronic intestinal diseases or known family syndromes.
“It is important to know how to recognize the symptoms that may make you suspect the presence of this tumor. A change in bowel habits, the presence of blood in the feces or a large amount of mucus, a sudden lack of iron and a consequent major weakness are signs that deserve further investigation. The most important test is colonoscopy, however, your doctor must always mediate this route.
The novelties in surgery
“A few years ago we had to select the simplest patients to be able to apply for minimally invasive surgery, today the selection is almost the opposite and we find ourselves having to select the patients to undergo open surgery (traditional) because in the centers of reference the treatment of colorectal problems can be addressed with minimally invasive techniques in the first place.
The novelties are many and range from advanced laparoscopic minimally invasive surgery, to robotic surgery, to the introduction of fluorescence, a technology that allows us to see the vascularization of the intestine in a more precise way during the surgery and thus to choose the point at which to place the suture with greater certainty “.
The TaTME (Transanal Total Mesorectal Ecision) technique
“It is a radical change of perspective for operating on the rectum. Traditionally, we entered the area to be worked on from the abdomen, then descending towards the pelvis, but now, thanks to this technique, which has taken hold in the last two years, we reach the operating area through a transverse route, going upwards from the bottom. This allows us a better vision of the final part of the rectum”.
Inflammatory bowel diseases
“In most cases, medical therapy is sufficient for inflammatory bowel diseases. In cases where you cannot control your disease activity with medications, you can evaluate surgery options. When the operation is indicated, it should not be postponed because there is a risk of compromising the patient’s general condition to such an extent that he or she will still have to undergo surgery, but in more severe conditions”.
“In the case of diverticular disease, surgery is performed only in the presence of complications. The diverticula do not require surgery or even therapy until they become symptomatic, in which case they can be treated with medical therapy. On the other hand, when abscesses, stenosis, perforations or symptoms develop that cannot be treated with medical therapy, we can consider the surgical intervention that consists in the removal of the intestinal tract that includes most of the diverticula”.