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Difference between revisions of "Colon"
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more grossing section
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(more grossing section) |
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# lower anterior resection (LAR) - proximal rectum +/- sigmoid (for proximal rectal malignancies). | # lower anterior resection (LAR) - proximal rectum +/- sigmoid (for proximal rectal malignancies). | ||
# abdominoperineal resection (APR) - anus + rectum - results in a permanent stoma (for distal rectal malignancies). | # abdominoperineal resection (APR) - anus + rectum - results in a permanent stoma (for distal rectal malignancies). | ||
==Grossing== | |||
*Lymph nodes - should get at least 12 - if it is cancer.<ref name=pmid18780863>{{cite journal |author=Bilimoria KY, Bentrem DJ, Stewart AK, ''et al.'' |title=Lymph node evaluation as a colon cancer quality measure: a national hospital report card |journal=J. Natl. Cancer Inst. |volume=100 |issue=18 |pages=1310–7 |year=2008 |month=September |pmid=18780863 |doi=10.1093/jnci/djn293 |url=http://www.medscape.com/viewarticle/581463}}</ref> | |||
''Quirke method'' | |||
*Bowel is not opened. | |||
**References: <ref name=pmid18667357>{{cite journal |author=West NP, Morris EJ, Rotimi O, Cairns A, Finan PJ, Quirke P |title=Pathology grading of colon cancer surgical resection and its association with survival: a retrospective observational study |journal=Lancet Oncol. |volume=9 |issue=9 |pages=857–65 |year=2008 |month=September |pmid=18667357 |doi=10.1016/S1470-2045(08)70181-5 |url=}}</ref>, <ref name=pmid18541901>{{cite journal |author=West NP, Finan PJ, Anderin C, Lindholm J, Holm T, Quirke P |title=Evidence of the oncologic superiority of cylindrical abdominoperineal excision for low rectal cancer |journal=J. Clin. Oncol. |volume=26 |issue=21 |pages=3517–22 |year=2008 |month=July |pmid=18541901 |doi=10.1200/JCO.2007.14.5961 |url=}}</ref>. | |||
''Standard method'' | |||
*Bowel is prep'ed by opening it along the antimesenteric side. | |||
*Dimensions - length, circumference at both margins. | |||
*Radial margin/circumferential margin - should be painted. | |||
**Rectum starts/sigmoid ends @ place where serosa ends on the posterior aspect of the bowel. | |||
***The proximal, anterior aspect of the rectum has serosa, i.e. it is not painted. | |||
==Common clinical problems== | ==Common clinical problems== | ||
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{{main|Colorectal tumours}} | {{main|Colorectal tumours}} | ||
These are very common. The are covered in a separate article entitled ''[[colorectal tumours]]''. | These are very common. The are covered in a separate article entitled ''[[colorectal tumours]]''. | ||
==Solitary rectal ulcer== | ==Solitary rectal ulcer== | ||