Laparoscopic surgery for small bowel tumours

Laparoscopic surgery for small bowel tumours

• 1.
  Laparoscopic Surgery forSmall Bowel Tumours Symposium on Diseases of the Small Intestine, Jaslok Hospital, Dec. 9-10, 2006 Abeezar I. Sarela MSc MS FRCS The General Infirmary at Leeds University of Leeds School of Medicine
• 2.
  Objectives Role oflaparoscopy Surgical technique Tumour-specific indications GIST Adenocarcinoma Lymphoma Metastasis
• 3.
  Role of LaparoscopicSurgery Extending Paradigms for Colorectal & Upper GI Carcinoma Diagnosis Staging Palliation Curative Resection Post-operative mechanical problems Adhesive obstruction Incisional hernia
• 4.
  Location-Specific Resection DuodenumSegmental resection Pancreaticoduodenectomy Jejunum Ileum Segmental resection Ileocolic resection
• 5.
  Technical Issues Laparoscopically-assistedresection Totally laparoscopic resection Anastomosis Extra-corporeal Intra-corporeal Additional organ resection Lymphadenectomy
• 6.
  Techniques 1 23 4
• 7.
  Small Bowel GISTBiological Implications for Laparoscopic Resection Wide heterogeneity in size and consistency Lymphadenectomy not necessary Sarcomatosis is rare
• 8.
  Laparoscopic Resection SmallBowel GIST 2000-2005 Mount Sinai Medical Centre, New York 15 patients Median size: 3.7cm (0.4-8.5) Conversion: 2 patients 1 major complication: anastomotic bleeding Nguyen et al. Surg Endosc 2006;20:713-716
• 9.
  Duodenal Adenocarcinoma Survivalis distinct from Pancreatic Cancer Yeo CJ et al (Johns Hopkins). Ann Surg 1998;227:821-31
• 10.
  Duodenal Adenocarcinoma Survivalis similar to Gastric Cancer Sarela AI et al (Memorial Sloan Kettering). Ann Surg Oncol 2004;11:380-386
• 11.
  Duodenal Adenocarcinoma 137patients 1983-2001 Potentially curative resection: 53% Pancreaticoduodenectomy: 78% Isolated duodenal resection: 22% Median diameter 4 cm (1.5-11) pN1: 43% - significant prognostic factor ≥ 15 lymph nodes: important for prognostic discrimination Sarela AI et al (Memorial Sloan Kettering). Ann Surg Oncol 2004;11:380-86
• 12.
  Laparoscopic Staging ofSmall Bowel Carcinoma Using the Gastric Carcinoma Paradigm Period: 1993-2002 Total 1748 patients Selection criteria for laparoscopy: Radiological M0 Acceptable risk for major operation No obstruction or bleeding Laparoscopy 657 patients Laparoscopic M1 23% Sarela AI et al (Memorial Sloan Kettering). Ann Surg. 2006;243:189-95
• 13.
  Small Bowel CarcinomaAnterior abdominal wall limits the extent of mesenteric retraction for radical lymphadenectomy Transverse colon tumours excluded from trials of laparoscopic colorectal resection. Guillou P.J., PI, UK MRC CLASICC study Dissection of greater omentum and omental bursectomy are limiting steps of laparoscopic D2 gastrectomy
• 14.
  Primary Small-bowel LymphomaLaparoscopy for Diagnosis & Staging
• 15.
  Small Bowel MetastasisPalliation Laparoscopic resection Laparoscopic bypass
• 16.
  Summary Radiological suspicionof small bowel tumour Laparoscopy for diagnosis Reasonable to extend paradigms for gastric carcinoma Staging of carcinoma and lymphoma GIST: Always consider laparoscopic resection Bowel resection-anastomosis techniques are well-established & safe