Left colon

– – Definition : cancer of the left colon

Definition

The cancer of the left colon is localised in the left part of the colon who goes from to the angle colic left or sigmoid.

This surgical pathology is treated with a left colectomy.

It is about a resection of the left colonist, with re-establishment of digestive continuity.

It is carried out thanks to a joining (= anastomosis colo-colic) between the left colonist proximale (or the transverse colonist) and the sigmoid colonist (or rectum)

– – Risk factor left colon cancer

Polyps:

between 60 and 80% of cancers of the colon develop on précancéreuses benign tumours: polyps or adenomata. The frequency of these lesions increases regularly with the years. According to the observations collected at the time of autopsies, 12 % of the people of less than 55 years are reached by it.

Old:

Rare before 40 years, cancers of the colon

Heredity:

All in all, the existence of a cancer in a relative of the first degree would multiply by two the risk of cancer.

Family forms

Certain family diseases involve a main risk of cancer of the colon. It is in particular the family adénomateuse polypose, which are characterized by the early appearance of multiple polyps on all the colon, and the syndrome of Lynch.
The early development of a cancer is inescapable in the event of polypose family
In the syndrome of Lynch, the risk is extremely high, but a little later. It is associated an increase with the frequency of cancers of the endometer like, to a lesser extent, other cancers (stomach, ovary, urinary tracts…).
 

MICI

The influence of the disease of Crohn on the cancer of colon remained discussed a long time.
The ulcéro-hemorrhagic rectocolite is a classical risk factor of cancer colorectal. However, the risk is function of the extent of the attack colic and its seniority
Today, it seems clear that this disease is also an important risk factor when it reaches all the colon and that it began young person.
 

Supplies

Other risk factors of cancer of the colon were evoked, such as a food low in fibres and rich in grease.
In addition certain data suggest that the chronic anti-inflammatory drug catch not stéroïdiens could play a protective role. But these factors remain very discussed.

Other risk factors of cancer of the colon were evoked, such as a food low in fibres and rich in grease.
In addition certain data suggest that the chronic anti-inflammatory drug catch not stéroïdiens could play a protective role. But these factors remain very discussed.

– – Signs and Symptoms of the cancer of the left colonist

The signs and symptoms of cancer colorectal can also be caused by other medical affections.

Consult a doctor so unusual symptoms appear.

weight loss
anaemia

change of the intestinal transit time
persistent diarrhoea
persistent constipation
contracting of the saddles (caused by a blocking partial of the large intestine)
saddle sanguinolent, red, bleeding of the rectum between the defecations
mucus in the saddles
feeling of incomplete evacuation of the intestine
imperiosity or need pressing to go to the saddle
abdominal discomfort or cramps pain
mass sometimes felt in the abdomen
distension, gas
feeling of plenitude
tiredness

– – traitement chirurgicale

LEFT COLECTOMY

LEFT OR SEGMENTARY INDICATIONS OPERATIONAL COLECTOMIE

Cancer of the left colonist:  angle colic left, colonist going down, sigmoid
 

Polyp colic not résécable by endoscopy

LEFT OR SEGMENTARY TECHNIQUE COLECTOMIE

The carcinological intervention comprises a exérèse carrying the tumour with safety margins and the ganglia which will be analyzed to have the staging of the tumour and to make it possible to pose the indication of a complementary treatment (chemotherapy) in the event of ganglionic metastatic invasion.

It is necessary to carry out a binding first of the lower mesenteric vein and then of the artery lower than 2 cm of its origin

Is the re-establishment of continuity carried out in same time with mechanical anastomosis (manual) termino-side or termino-final?

? The resection right colic is carried out:   either by a traditional technique or by laparoscopy (coelioscopy, closed belly)
The operational act is longer in coelioscopy than in open surgery.

?? Is the resumption of the transit and the food probably faster after left colectomy by laparoscopy (coelioscopy).??

The duration of hospitalization is probably not very different according to the technique used.
?? The carcinological quality of the resection and postoperative quality of life are not different for the laparoscopy (coelioscopy) and the open surgery.

OPERATIONAL PRE RÉGIME

A mode without residues (without fibres) is recommended during the 8 days which precede the intervention. The purpose of it is to prepare the intestine.

COLIC PREPARATION

It can be to you prescribed in residence (Citra fleet 2 sachets) and be supplemented the intervention day before to the private clinic with a rectal injection

– – complications after resection of left colon

They are rare. It is about a surgery frequently carried out.
The technique, either by laparoscopy, or by opened way, is standardized, sour and reliable.

The major complication after resection is the anastomotic dent.

The major complication after resection is the anastomotic leak.
The rate of anastomotic leak symptomatic is comparable after right colectomy and left colectomy; The risk of dent is estimated between (1% and 3%)
It is about a matter escape through the joining colic because the joining is not tight.

This leak can involve a post-operative peritonitis, which imposes a reintervention in urgency and sometimes the clothes industry of a stomy proximale (anus artificial temporary: 3 -6 months) with disassembling of anastomosis (intervention of Hartmann)

Obstruction of the bowels

It is about an occlusion of hail

A difficult resumption of the transit can make necessary the realization a scanner to eliminate diagnoses it postoperative obstruction of the bowels on support or internal hernia (imprisonment of a handle of hail in a breach created by the intervention).

Abscess of walls

rare after laparoscopic surgery

Other risks are inherent in any act of abdominal surgery
haemorrhage

attack of another abdominal body

Wound or section of the left ureter: exceptional, in the event of major ignition or of adherent tumour to the ureter.

Wound of the failure: exceptional. This wound occurs in the event of difficult mobilization of the left angle is difficult. This problem appears by an operational haemorrhage post (fall of the rate of haemoglobin). In the event of important lesion and operational haemorrhage post (fall of the rate of haemoglobin) a reoperation can be necessary (splenectomy = ablation of the failure).

Wound of the hail or attack of another body abdominal: xceptionnel.
This wound occurs in the event of difficult mobilization of the left angle is difficult. This problem appears by an operational haemorrhage post (fall of the rate of haemoglobin). In the event of important lesion and operational haemorrhage post (fall of the rate of haemoglobin) a reoperation can be necessary (splenectomy = ablation of the failure).

Infections

Urinary infections, superinfections bronchial, flebite on catheter periferic: daily monitoring post operational and application of preventive measures (fast ablation probes urinary, early mobilization, respiratory kinesitherapy, ablation of the perfusions, early D food).

LEFT COLON IN AMBULATOIRIAL REGIMEN

Transverse Colon

Cancers transverse colon : Définition

Cancers transverse colon

Cancers of the transverse colon account for approximately 10% of colorectaux cancers. Their diagnosis is often late; they appear in a complicated form in 30 to 50% of the cases (occlusion, perforation, internal dent). The evolution of the symptoms is often insidious. The tumours of the colon tranverse right often bulky, are sometimes suppurated in the former abdominal wall or the rétropéritoine. They can also invade the bodies of vicinity and fistuliser. The tumours of the left transverse colon are often small occlusive cancers sténosant. The T4 forms account for 20 to 40% of the cases. The voluminal tomodensitometry is the most powerful examination to carry out the assessment of extension of these tumours of advanced stage. Because of their central localization in the abdomen and of the frequency of the evolved forms, the differential diagnoses of the tumours of the transverse colon are numerous. Cancers of the median transverse colon pose problems of ganglionic clearing out and re-establishment of continuity. The choice of the type of resection depends in particular on the anatomical conditions. The loco-regional repetitions are presented in the form of tumoral masses fixed at the retro peritoneum. The surgical series concerning the tumours of the transverse colon date from the years 70-80. The surgery was curative in less than 50% of the cases. Morbi-mortality was of approximately 20%. Total survival at 5 years was lower than 35%. The tumours of the transverse colon were bad forecast.