Surgery for colorectal cancer involves the removal of the diseased portion of the intestine and the nearby lymph nodes. As regards tumors that arise in the last centimeters of the intestine, in this case a careful preoperative study is necessary to establish the position of the tumor: if the neoplasm is particularly close to the last tract of the intestine, the intervention is demolitive and involves the placement of a sterile collection container, unfortunately permanent.
Thanks to a new surgical technique, however, in most cases it is possible to save the natural intestinal function both through the use of sophisticated surgical dissection systems, with an innovative minimally invasive technique called TA-TME (Trans Anal Total Mesorectal Excision), both using pre-operative radiotherapy and chemotherapy treatment. This operation allows the tumor to be radically removed while leaving the last section of the intestine unharmed, by practicing a suture between the latter and the colon. The post-operative period is characterized by a specific functional rehabilitation of the pelvic floor muscles, associated with particular dietary and nutritional indications. The patient will then be followed up periodically at the clinics.
“When we talk about cancer, the priority theme is to intervene to save the life and heal the patient. But at the same time it is important, especially for certain pathologies that require demolition interventions, to try to guarantee them the subsequent quality of life – underlines the regional councilor for Health Policies Raffaele Donini -. This is not a secondary aspect, on the contrary, the quality of a health system is also measured on this. That is, on the fact that research and clinical technique are also aimed at maintaining good living standards for patients suffering from serious pathologies. This one from Ferrara is an example that goes exactly in this sense ”.
“Research is the driving force for ensuring better health care. This aspect characterizes the Ferrara University Hospital ”, where teaching, research and assistance are integrated, a priority mission of the Hospital. These are the words of Dr. Paola Bardasi, Extraordinary Commissioner of S. Anna.
“Regarding the treatment of cancer patients – continues Bardasi – it is important to follow the person in all phases of his pathology, from diagnosis to controls. Here the fundamental role of follow-up takes over as a guarantee of continuity of care and taking charge of the patient, which has the benefit of having an ever higher quality of life.. Taking care of the patient is the basis of the work of the numerous teams of different specialists, of the professionals of the Cona hospital, not only with regard to this specific new technique, presented today, but also in other treatment paths, demonstrating that ” hidden healthcare ”which plays an important role in care. One example among many is the path dedicated to women with breast surgery. One of our tasks is to give credit and account for the opportunities, improving knowledge and access, to all citizens not only of Ferrara, of our Region and of other Regions ”.
The surgical and rehabilitation team is composed of: prof. Paolo Carcoforo, dr. Daniele Marcello, dr. Giorgio Soliani, Dr. Simona Ascanelli.
“The surgical technique we apply in Surgery 2 – declares prof. Paolo Carcoforo – is not widely used nationally. This means that Ferrara represents a reference center for the treatment of this pathology. The goal is to guarantee the best possible result in an oncological sense, minimizing the damage to the patient: pain, hospitalization times and post-operative consequences. It is essential to underline the importance of rehabilitation-functional treatment, especially at the level of the pelvic floor, and the preservation of natural intestinal function. The objective is twofold: on the one hand to obtain a minimally invasive result for the patient, on the other hand to guarantee quality even in post-operative recovery “.
“This new technique – says Dr. Daniele Marcello – was recently applied at Surgery 2 and consists of a laparoscopic intervention with a dual approach, both abdominal and trans-anal. This type of intervention saves the sphincter apparatus in the treatment of rectal injuries and brings significant benefits to the patient. The lesion is in fact removed without invasive interventions. Obviously, the surgical technique must then be helped by a functional rehabilitation in the post-operative period “.
To perform this type of surgical operation, the team of prof. Paolo Carcoforo, Director of the Operative Unit of Surgery 2 of the University Hospital (Arcispedale “S.Anna” of Ferrara) who, among other specializations, has always been involved in the surgical and rehabilitative treatment of pelvic floor pathologies. These specific skills have made it possible to optimize the TA-TME, which involves the presence of two teams operating simultaneously with an abdominal and trans-anal laparoscopic approach on the pelvic floor, using two different high-definition videos. The operation involves the removal of the diseased intestinal tract directly through the anus; for this reason the patient will have only four surgical scars of 1 cm, unlike the traditional surgery which would have involved a cut in the abdomen associated with a permanent stoma.
As for all other patients undergoing colon surgery, an accelerated recovery protocol called ERAS (Enanced Recovery After Surgery) is applied in the Department of “Surgery 2” of S. Anna, which provides for an early resumption of functional activities, with a faster return to home and to their activities, associated with minimal use of painkillers. These patients will then be taken care of by a dedicated rehabilitation clinic and will undergo a series of specific treatments (electrostimulation, biofeedback, peristeen) for a more rapid and optimal recovery of the stool elimination functions.
“When you are diagnosed with cancer your life changes completely”. These are the words of Mauro Govoni from Ferrara, 61, who recently underwent this surgical technique. “After having screened for the prevention of colorectal cancer – recalls Govoni – in July 2020 I tested positive. Following this I underwent a colonoscopy which detected the tumor. Immediately after Dr. Marcello, with extreme clarity and sincerity, explained to me the path to follow for the removal, foretelling me that I would have to undergo a momentary heliostomy. On October 16th I underwent surgery and the new technique of the surgical team of prof. Carcoforo allowed me to remove – after a few months – the stoma. My path, even if challenging, leads me to say that only early diagnosis and regular prevention can save human life. I want to conclude by recognizing that in my articulated journey I have been able to see the great professionalism and dedication of all the health personnel ”.
This approach in the treatment of a tumor it represents the second cancer by incidence in Italy, it combines the surgical aspect with that of rehabilitation and represents a further step forward for an increasingly less invasive treatment of patients. However, prevention plays a fundamental role. The screening program of the Emilia – Romagna Region for colorectal cancer is aimed at men and women, between the ages of 50 and 69, invited every two years to perform the test for the search for occult blood in the faeces .