SINGAPORE, June 8, 2022 /PRNewswire/ -- Dr Aaron Poh shares advanced surgical techniques for Colorectal Cancer. Full text is as follows:

Colorectal Cancer

According to the World Cancer Research Fund, Colorectal Cancer is the third most common cancer in the world. In Singapore, it is the most common cancer found in men and the 2nd most common in women after breast cancer.

Colorectal cancer is treated with the removal of the tumorous segment of the colon or rectum with the associated lymph nodes. This is known as a colectomy (for the colon) or anterior resection (for the rectum). The conventional approach is via open surgery. Open surgery is still very much in use for advanced tumours.

A minimally-invasive alternative is laparoscopic (keyhole) surgery. Unlike an open approach, laparoscopic surgery involves small incisions made to the abdomen and is carried out using a laparoscopic camera and laparoscopic instruments. The surgery is carried out in a similar fashion to open surgery and the cancerous portion of the colon or rectum is excised. As laparoscopic surgery involves smaller incisions as opposed to open surgery, the patient can expect to experience faster recovery and less pain.

However, recent advancements in technology have brought about more novel ways of achieving excellent outcomes safely and effectively with less trauma to the body. 

Natural Orifice Transluminal Endoscopic Surgery (NOTES)

Natural Orifice Transluminal Endoscopic Surgery provides a "scarless" alternative to laparoscopic surgery and is borne from the evolution of endoscopy and laparoscopy surgery. Part and sometimes the whole surgery is performed through a natural opening in the body, i.e. the anus and rectum.

Laparoscopic instruments are used to perform the procedure within the lumen of the anus and rectum. This provides all the advantages of laparoscopic surgery, with the added benefits of better cosmetic results, less pain, faster recovery and a decreased risk of incision-related complications.

Transanal Endoscopic Microsurgery (TEMS) and Transanal Total Mesorectal Excision (TaTME)

Transanal Endoscopic Microsurgery (TEMS) and Transanal Total Mesorectal Excision (TaTME) are different variants of NOTES procedures for treating rectal cancer. The evolution of such techniques arises due to the need to preserve as much rectal function as possible to allow minimal disruptions to bowel movements after surgery.

Transanal Endoscopic Microsurgery (TEMS) is a minimally-invasive method of treating pre-cancerous or early-stage rectal tumours, and is performed entirely through the anus. As no incision is necessary, it is an excellent alternative that offers much quicker recovery and is virtually painless. It is also a viable option for polyps found in the rectum that cannot be removed by a colonoscopy procedure.

TEMS involves the use of equipment developed for use within narrow cavities. A magnifying camera with three-dimensional visualisation provides better exposure and visualisation for the surgeon. The TEMS technique also allows the surgeon to successfully reach proximal lesions inside the rectum that were previously only accessible with major abdominal surgery.

Transanal Total Mesorectal Excision (TaTME) is a minimally-invasive alternative/adjunct for treating mid- and low rectal cancer in patients who may be difficult candidates for full laparoscopic surgery. TaTME involves a combined laparoscopic and transanal approach that allows tumour removal. The eventual oncological outcome is the total removal of the rectum with the tumour, along with the surrounding fat and lymph nodes.

The distal margin is the clear rim of normal tissue below where the tumour is located. In conventional rectal cancer surgery, this margin is difficult to discern. TaTME allows the surgeon to control and define the distal margin, providing better distal margin control, which is a crucial point of the procedure.

This procedure allows the surgeon to overcome visualisation challenges and remove low rectal cancers in challenging body anatomy conditions without having to resort to open surgery.

These "down-to-up" procedures are generally considered more technically challenging to perform because they differ from how surgeons have traditionally performed surgery and is not widely practised. NOTES surgery requires a lot of patience, technical skills and continuous clinical practice.

Summary

NOTES procedures provide a new avenue for treatment of patients with benign and malignant lesions of the anus and rectum that would have otherwise warranted major resectional surgery. Both TEMS and TaTME do not involve long abdominal incisions and instead, both procedures are performed transanally with a "down to up" approach. NOTES procedures also minimise the length of the rectum removed and this, in turn, translates to better bowel control after surgery.

About Dr Aaron Poh

Dr Aaron Poh is a General Surgery specialist with dual subspecialties in Colorectal surgery and Trauma surgery. He is currently the Medical Director at Alpine Surgical Practice.

He performs a range of endoscopic and surgical procedures. Endoscopic procedures include gastroscopy and colonoscopy, with an emphasis on advanced procedures such as complex polyp removal with Endoscopic Mucosal Resection (EMR) and ESD (Endoscopic Submucosal Dissection). In addition, he also performs Colonic Stenting, which is particularly advantageous in helping patients with obstructed colon cancers avoid having a permanent stoma. Surgical procedures are largely performed laparoscopically and include colon cancer surgery, hernia repair surgery and gallbladder removal, among others.

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SOURCE Alpine Surgical Practice