Colorectal cancer, the main Italian experts discuss surgical complications at the Campus Bio-Medico University Hospital

Today and tomorrow the conference "The anastomotic failure" to deal with the clinical, pathophysiological and technical aspects of intestinal anastomosis. Confirmed the attention of the Campus Bio-Medico of Rome to the second big killers Italian, colorectal cancer with the opening of the clinic open for prevention and treatment

 July 11, 2019 – A serious complication that puts the person's life at risk. On the anastomotic leak, a problem of the intervention of anastomosis in the case of for colorectal cancer patients, the Campus Bio-Medico University Hospital promotes today and tomorrow a national conference, entitled "The anastomotic failure", attended by the leading Italian experts.

With anastomosis surgery, the colon is incised to remove the part where the tumor persists and the two flaps are then sutured. Right from the start, the passage of intestinal contents represents a risk: "If the suture does not heal, the complication that emerges is anastomotic leak", explains the teacher Marco Caricato, head of the Geriatric Surgery unit and associate professor of general surgery at the University Hospital of the Campus Bio-Medico in Rome.  "To avoid this, the content must be released before it passes over the suture through a ostomy, i.e. an external intestinal shunt, to be performed before the anastomosis".

Talking about colorectal cancer treatments in Italy is important. The type of neoplasm in fact represents the second big killers: "It ranks second among all types of cancer in both men and women in terms of mortality and incidence", recalls Professor cartoonish. Based on the 2018 Report "Cancer in Italy" by Aiom, the mortality of patients with colorectal cancer is in fact 11 percent in males and 12 percent in females while the incidence is 15 percent in men and 13 percent in women.

At the Campus Bio-Medico University Hospital, a outpatient clinic with access open, or without the need for an appointment but on the suggestion of the general practitioner. "The key tool in the prevention of colorectal cancer is screening, i.e. examinations for the general population to see if there are conditions that predispose to the development of a tumor or, alternatively, the verification of its presence. Screening is part of the essential levels of assistance, however not all local health authorities are able to implement programs with complete coverage, and above all not all patients adhere. At the outpatient clinic of the Campus Bio-Medico University Hospital we aim to make available to the patient all the tests needed to know if the occult blood found in the faeces is a false positive or alternatively if there is a polyp or if the disease is at an advanced stage".

To prevent the formation of the neoplasm, it is necessary to intervene in time, when the first lesions emerge. "We know very well the stages of tumor development, starting from a lesion, called adenomatous polypto the actual tumor. It is a process that occurs in 80 percent of cases and can last 5-10 years. If we manage to intercept the patient before the lesion has become a tumor, we can treat it more easily, generally, with an endoscopic removal", recalls Caricato. 

The clinic dedicated to prevention is just the latest example of the attention given to colorectal cancer by the Campus Bio-Medico University Hospital. "The total of colorectal surgery operations here at Campus Bio-Medico are 250 every year, of which a very high percentage are performed in laparoscopy to make the patient suffer less", comments the professor cartoonish. In particular, on the basis of data from the regional outcome evaluation program (http://www.dep.lazio.it/prevale2019/index.php), operations performed with laparoscopy in 2018 were 67 out of 100 colon cancers.

The numbers of the Campus Bio-Medico Polyclinic are largely in line with the indications of the Ministry of Health. According to the National Outcomes Plan of the Ministry of Health (Pne 2016), in fact, out of 27.019 operations for colorectal cancer it emerged that survival after 30 days in hospitals that perform more than 50 operations a year is equal to 97 percent while in the structures below the threshold of 50 interventions the percentage drops to 95 percent, that is to say a difference of 151 more deaths.

Also, in the initial stages of colon cancer disease, an important role is played by operative endoscopy. "Our endoscopy - observes the professor - is able to deal with cases that in the majority of other healthcare facilities would be treated surgically. We are proud of this because we have an endoscopy that offers us the best. Another strong point is the multidisciplinarity because our unit collaborates with endoscopists, radiotherapists and oncologists".

Finally, at the Campus Bio-Medico University Hospital, the patient is started on a path of ERAS, i.e. accelerated healing after surgery. "It is a question - explains Professor Caricato - of a series of surgical but not strictly technical measures, such as for example nutrition, mobilisation, collaboration with nurses. In this way the person interrupts their habits as little as possible: does not stop eating or walking, does not put the tube and drainage and after a few days goes home. This does not offer differences from an oncological point of view but in terms of quality of life, assistance and, based on some evidence, it also reduces complications".