Surgery plays a key role in the treatment of digestive system neoplasms: recent studies indicate that out of 100 successful recoveries, 2/3 are made possible exclusively by surgical treatment, the other 1/3 is made possible by a combination of surgery and other traditional therapies (radiotherapy and chemotherapy, also called adjuvant therapies).
The primary purpose of cancer surgery is to remove the tumor (also called malignant neoplasm) as radically as possible. These types of cancer surgery are also defined R0 resections, as they involve the complete resection of the all tumor, with no microscopic residual left.
Many studies today indicate that combining surgical treatment with adjuvant therapies may maximize local tumor control and improve systemic control of cancer cells migrated from the primary tumor. Adjuvant therapies can be given before the surgical treatment, in which case they are called neoadjuvant therapies. Neoadjuvant therapies aim to reduce the size of the cancer and inhibit further metastatization, minimizing the risk of cancer recurrence.
Laparoscopic surgery plays a key role in diagnosing cancer: it can establish an exact diagnosis through a minimally-invasive 360° exploration of the abdominal cavity (staging) that determines the presence and extent of carcinosis (metastases smaller than 5mm in diameter that are not detected through traditional techniques of diagnosis). This way, unnecessary laparotomies can be avoided.
Being less invasive, laparoscopic surgery is ideal to minimize surgical trauma associated with traditional open procedures, leading to better post-operative conditions in the patient. This factor is estimated to reduce the risk of immunosuppression after surgery and to increase tolerance for adjuvant therapies, improving the patient’s response to such therapies.
Laparoscopic colorectal surgery to treat colonic neoplasms, sigmoid colon cancer and anorectal cancer
Laparoscopic surgery is particularly useful to treat these types of cancer, as the oncological principles applied are the same as those for open surgery.
Most traditional surgeries to remove colorectal tumors can also be performed using the laparoscopic technique (right hemicolectomy, left hemicolectomy, sphincter-saving anterior rectal resection, abdominoperineal resection). Being minimally invasive, laparoscopic surgery is estimated to help patients better cope with adjuvant and neoadjuvant therapies after the operation. It allows a shorter recovery and reduces the risk for postoperative complications. Laparoscopic colorectal procedures last about 120′-140′; they involve the use of 4-5 incisions and an additional small skin incision (4 to 5 cm long) through which the damaged part of the intestine is removed.
Average duration of hospital stay for over 80% of patients undergoing laparoscopic colorectal surgery is 3 days. During the procedure, anesthesia is administered using epidural catheters. This way the patient can consume solid food after a few hours, walk after 1 day and be discharged from the hospital after 3 days. For more information on epidural anesthesia, do not hesitate to contact our anesthesiologist before your surgery.
Laparoscopic surgery for stomach cancer
A gastrectomy is the surgical removal of all or part (usually two thirds) of the stomach due to damages and complications caused by ulcer disease or cancer. Traditionally, the surgery is performed by making an incision through the abdominal wall. In some cases though, and on candidate patients only, it may be performed using the laparoscopic approach. The continuity of the digestive tract is restored by joining a segment of the intestine directly to the esophagus (in case of total gastrectomy) or to the remaining portion of the stomach (in case of partial gastrectomy).
Laparoscopic surgery for pancreatic tumors
Pancreas cancer surgery may involve the partial or total removal of the pancreas, although this last option is less common. Traditionally, the surgery is performed by making a single incision in the abdomen. In some cases though, and on candidate patients only, the laparoscopic approach can be a valid alternative. Simple laparoscopic surgery is particularly effective to remove tumors located in the body or tail of the pancreas, while minimally-invasive robot-assisted surgery is currently the favored option to treat tumors located in the head of the pancreas.
Laparoscopic surgery for liver cancer
Liver cancer treatment may involve the surgical removal of part of the liver. Liver resection can range from small (removal of one or less than one segment) to major. Resection of a large portion of the liver is possible because the remaining liver grows to compensate for the part that was removed. If tumors are confined to the left lobe, laparoscopic surgery can be an effective treatment option. In some cases radiofrequency thermal ablation is used to treat hepatic nodules and destroy tumoral tissue. Radiofrequency thermal ablation can be also performed using laparoscopic surgery.
Laparoscopic surgery for adrenal benign and malignant neoplasms (Adenoma and Pheochromocytoma)
Adrenal tumors are tumors occurring in the adrenal glands that cause the endocrine system to hyper function, leading to high levels of hormone cortisol in the blood and high blood pressure. The laparoscopic procedure performed to treat them lasts about 90′-180′. It involves the use of 3-4 small incisions (0.5 to 1 cm long) and the removal of one or both adrenal glands. The patient can be discharged just 48 hours after surgery, although in some cases the hospital stay is prolonged to prevent hormone imbalances in the patient. The patient can resume normal activities just 10 days after surgery.
