CRS

Question 1

Villous adenoma

Answer 1

Occasionally cause HypoK

Question 2

Hartmann’s operation

wiki

Answer 2

aka Proctosigmoidectomy

• Resection of rectosigmoid colon
• Closure of the anorectal stump
• Proximal end colostomy or ileostomy

Use in emergency surgery when primary anastomosis is not possible

Question 3

Abdominoperineal resection (APR)
WCS

Answer 3

• For very distal rectal cancer (<5cm from anal verge)
• Synchronous abdominal + perineal resection
• Permanent colostomy

Question 4

Anterior resection

Answer 4

Anterior resection
- Resection of rectum with colorectal anastomosis

Lower anterior resection: -
- Mobilization down to distal rectum and anastomosis at the level below peritoneal reflexion

Question 5

Amsterdam criteria for HNPCC

Hereditary nonpolyposis colorectal cancer

Answer 5

3-2-1 rule

> =3 relatives with histologically confirmed CRC - FAP excluded

> =2 successive generations involved

> =1 Dx before Age 50y

Question 6

Blood supply of Colon and Rectum

Answer 6

SMA (L1)
–> Ileocolic, Right colic, Middle colic

IMA (L3)
–> Left colic, sigmoid, superior rectal

Internal iliac (L4)
--> Middle, inferior rectal

Marginal a. of Drummond

• -> Connects SMA and IMA (from ileocolic junction to rectum)
• Runs along inner perimeter of large bowel in the mesentery

Arc of Riolan

• Connects Middle colic (of SMA) to Left colic (of IMA)
• Close to root of mesentery

Question 7

Rectum

Answer 7

Within 12cm from anal verge

Question 8

Rectal CA margin

Answer 8

En-bloc resection (i.e. as a whole)
5cm proximally
2cm distally

7cm from anal verge can do spincter sparing

Question 9

Total mesorectal excision

Answer 9

For radial spread

Part of LAR for middle/lower rectal CA

Can prevent local recurrence