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Medical Edge Newspaper Column from Mayo Clinic
NEW SURGERY FOR COLON CANCER IS MINIMALLY INVASIVE
DEAR MAYO CLINIC: What’s this I hear about a new, low-invasive
colon surgery? Who is a proper candidate? — East Satellite Beach, Fla.
ANSWER: The procedure you are referring to, laparoscopic-assisted
colon surgery, is minimally invasive. It was recently in the news because
an international study led by Mayo Clinic found that, in the hands of
an experienced laparoscopic colon surgeon, the procedure is a safe and
effective treatment for selected patients with colon cancer. The seven-year
study involved 872 patients and 48 medical centers.
Our study team compared rates of complications, cancer recurrence, length
of time patients were cancer-free and the overall survival in patients
who had traditional surgery vs. the laparoscopic procedure. We found an
almost exact rate of cancer recurrence in both sets of patients, the survival
rate was almost identical, and there were similar complication rates.
However, the clear advantages of laparoscopic-assisted surgery include
a smaller incision, a shorter hospitalization, a swifter recovery and
less need for pain medication after surgery.
These findings are good news for patients. This year, about 100,000 people
will be diagnosed with colon cancer in the United States. More than 90
percent of them will need colon surgery to remove the cancer. As a result
of this study, many of them now have a choice of surgical procedures.
Unfortunately, it’s not an option for everybody. Patients not suited to
this approach include those who have: 1) cancer that has spread to other
organs; 2) bulky tumors that obstruct or have perforated the colon; and
3) other unusual conditions, such as scarring from multiple previous abdominal
operations.
Laparoscopic colon surgery typically involves the creation of three half-inch
incisions through which a small video camera and surgical instruments
are inserted. A two-inch incision is used to bring the colon out of the
abdomen. Surgeons examine the colon while it is outside of the body, cut
away the cancerous portion and reconnect the two healthy parts. Then they
reinsert the colon into the abdomen.
Patients are hospitalized for five days and must avoid strenuous activity
for six weeks. However, most can return to work and light activity within
a few weeks.
Heidi Nelson, M.D., Colon and Rectal Surgery, Mayo Clinic, Rochester,
Minn.
Additional Resources:
What
is Laparoscopic-Assisted Colon Surgery?
Appointment
Information
Information
on Colorectal Cancer
DEAR MAYO CLINIC: I feel like I have something stuck in my throat
and have had difficulty swallowing for more than a year. When I visited
my daughter in Florida, she sent me to her doctor, who said I have something
called a cricopharyngeal bar. Now I’m back home and don’t know what to
do. What is this thing, and what are my options? — Jamestown, N.Y.
ANSWER: The cricopharyngeus (krik-o-fair-IN-je-us) muscle is the
lowest horizontal, bandlike muscle of the throat. It works as a one-way
valve to keep stomach contents from coming into the throat. When it’s
working normally and you swallow, the cricopharyngeus muscle temporarily
relaxes to allow food to pass.
However, this natural relaxation associated with swallowing can be disrupted
by a number of diseases. When this happens, the cricopharyngeus muscle
functions as a bar that blocks the passage of chewed food. The result
can be difficulty swallowing. Patients who have this problem often complain
of feeling as if something solid is stuck in their throats.
I encourage you to go to an ear, nose and throat specialist to have this
evaluated. An image of the lower throat (an esophagogram) can reveal the
problem, as can other tests. If the muscle is not functioning properly,
surgery on the cricopharyngeus muscle may relieve the obstruction and
improve swallowing.
Historically, this surgery has been done through an incision in the skin.
Now surgeons are studying the effectiveness of endoscopic laser surgery.
Both the open and the endoscopic procedure may be done on an outpatient
basis or may require a one-night stay in the hospital.
Jan Kasperbauer, M.D., Ear, Nose and Throat Medicine, Mayo Clinic, Rochester,
Minn.
Additional Resources:
Treatment
of Cricopharyngeal Bar
Appointment Information
Information
on Swallowing Difficulties
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Medical Edge from Mayo Clinic is an educational resource and doesn’t
replace regular medical care. To e-mail a question, go to www.mayoclinic.org,
or write: Medical Edge from Mayo Clinic, c/o TMS, 2225 Kenmore Ave., Suite
114, Buffalo, N.Y., 14207. For health information, visit www.mayoclinic.com.
© 2004 TRIBUNE MEDIA SERVICES, INC.
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