Business Daily Media

Men's Weekly

.

"Colorectal Medical Education Encyclopedia" publishes article to explain how sphincter saving surgery make preservation of the anus in rectal cancer patients possible

HONG KONG SAR - Media OutReach - 5 September 2022 - In Hong Kong and many other regions, colorectal cancer remains one of the leading causes of cancer related death. Among all colorectal cancer patients, some patients suffer from low rectal cancer and the location of the tumour is very close to the anus, leading to the fear of whether they need to live with an ostomy for the rest of their life.



Sphincter saving surgery (preservation of anus) made possible with the advancement of surgical technology

General surgeon Dr Chu Kin Wah explains that whether to remove or preserve the anus during surgery are determined by a number of factors.

First is the distance between the anus and the tumour; the longer the distance, the higher the chance of preservation;

Second is whether there is a sufficient "surgical safety margin" remained after surgery. Normally an additional 5 cm and 2 cm from the tumour is the required surgical safety margin for colon and rectal cancer surgery respectively in order to achieve complete removal of the tumour;

Third is the size of the tumour. If the tumour size is too big, then preservation of the anus will be more difficult;

Fourth is about the difference in pelvic anatomy between men and women which constitutes to the success rate of the preservation of anus in rectal cancer surgery. A man's pelvis is shaped like an inverted triangle with the narrowest part at the bottom. Therefore, the lower the tumour is located in the rectum, technically the more difficult it is to preserve the anus. On the other hand, a woman's wider pelvis allows the insertion of surgical apparatus to facilitate the surgical procedure, hence the chance of preservation of anus is relatively higher. In exchange for preserving the anus, the patients will experience alteration of bowel habit after operation, mainly more frequent bowel motions. For elderly with pre-existing faecal incontinence, removal of anus could be a better option.

The milestone of sphincter saving surgery – Total Mesorectal Excision (TME)

In recent years, there is further understanding on the anatomy of the rectum and behavior of rectal cancer, it is generally agreed that the tumour spreads to peri-rectal lymphatic tissue in cranial direction, therefore the distal surgical resection margin can be narrowed down to two centimeters, saving more patients with low rectal cancers from permanent ostomy without compromise on the disease recurrence rate.

In the past, the local recurrence rate for rectal cancers after sphincter saving surgery could be as high as 50%. The medical breakthrough finally came in 1986, when Dr. R J Heald from the UK pioneered a new surgical technique -- Total Mesorectal Excision, or TME. Mesorectum is the fascia wrapping the rectum and contains the lymphatic tissue, in the past, this fascia will be destructed during rectal cancer surgery, exposing the cancer cells from the lymphatic tissue to the pelvis that leads to high local recurrence rate. With TME technique, the fascia was removed with rectum in intact manner.

Dr Chu Kin Wah further explains that the TME technique enables complete removal of the mesorectum together with the affected rectum, without exposing the lymph nodes. As a result, the cancer recurrence rate is drastically reduced to only 3%, depending on the surgeon's experience and skills on TME technique. In addition, new developments in surgical apparatus have a key role to play, such as the invention of a double stapler which allows surgeons to reconnect the rectum inside the very narrow space of the pelvis, increasing the success rate of sphincter saving surgery from 60% to 90%.

Mr. Lee, a 48-year-old rectal cancer patient expressed, "My tumour was only 5 cm away from the anus upon diagnosis and it was truly amazing when my surgeon told me that I was still able to keep my anus without the need of using an ostomy." Before the era of TME, situation like Mr Lee's case would end up in permanent ostomy as the least distance between the tumour and anus is 6-7cm if sphincter saving surgery is considered.

Complication of rectal cancer surgery

An anastomotic leak is a potential complication after rectal surgery. It occurs when the two ends of the bowel that have been connected together (anastomosis) do not heal completely, and faecal contents from the bowel lumen leak out. This will potentially lead to peritonitis, which can be life threatening and emergent operation may be required to control the infection. Generally speaking, the rate of anastomotic leakage in colon surgery is less than 5%, but in rectal surgery the leakage rate can be as high as 30%.

The probability of anastomotic leakage also depends on the location of the tumour. The rectum can be divided into three sections, namely the "lower", "middle" and "upper" sections, with 6 cm, 6-10 cm and 10-15 cm away from the anus respectively. The leakage rate after middle and lower rectal surgery is usually higher, while the leakage rate of upper segment is similar to that of a colon surgery.

Dr Chu Kin Wah reminds that the consequences of anastomotic leakage can be significant by causing peritonitis and severe sepsis that can be fatal. If such complications happen, not only the patients' recovery is delayed but also the cancer recurrence rate will be increased. To prevent this from happening, the surgeon will sometimes create a temporary ostomy for the patient, in order to prevent faeces and bacteria from contaminating the anastomosis.

Before the ostomy is closed, an x-ray examination will usually be performed in a 4-week time, in which the contrast medium named gastrografin will be injected through the anus into the body to examine if there is any possible leakage. If no leakage is shown in the x-ray image, it can imply that the anastomosis has already healed and the ostomy can be closed allowing the patients to pass bowel motions via the anus.

Notably, for diabetic patients and those who have previously received radiotherapy (such as treatment for cervical cancer), a longer healing time for the anastomosis (about 6-8 weeks) will be required before the doctor can close the temporary ostomy.


Hashtag: #Colorectalcancer #Rectalcancer #Preservationofanus #SphincterSavingSurgery #TotalMesorectalExcision #TME #ColonandRectumSurgery #GeneralSurgeon #DrChuKinWah

News from Asia

Highbrow Unveils Its New Beauty Salon at The Adelphi

SINGAPORE - Media OutReach Newswire - 27 June 2025 - HighBrow, one of Singapore’s most trusted names in brow, lash, and nail care, is thrilled to announce the launch of its new beauty salon at The...

Cyberport 5 as Hong Kong's New I&T Landmark

Driving Emerging Strategic Industries Development Heralding a New Chapter in Integration of I&T and the Community HONG KONG SAR - Media OutReach Newswire - 27 June 2025 - The Cyberport ...

VinFast signs dealer financing cooperation agreement with BCA

JAKARTA, INDONESIA - Media OutReach Newswire - 27 June 2025 - VinFast has officially entered into a pivotal financial partnership with PT Bank Central Asia Tbk. (BCA), one of Indonesia's leading p...

Food Expo PRO and Hong Kong International Tea Fair Return in August with New Coffee Zone and Expanded Halal Sector

HONG KONG SAR - Media OutReach Newswire - 27 June 2025 - Organised by the Hong Kong Trade Development Council (HKTDC), the Food Expo PRO and Hong Kong International Tea Fair will be staged concurr...

Food Expo PRO and Hong Kong International Tea Fair: One-Stop F&B Platform Returns in August

Spotlighting Food Science & Tech HONG KONG SAR - Media OutReach Newswire - 27 June 2025 - Organised by the Hong Kong Trade Development Council (HKTDC), the Food Expo PRO and Hong Kong Internat...

The best CFD broker 2025': Octa receives yet another award

KUALA LUMPUR, MALAYSIA - Media OutReach Newswire - 27 June 2025 - Octa, a globally regulated and trusted broker since 2011, was recently named 'The best CFD broker 2025' by the AllForexRating.com...

DHL Express completes the modernization of its Air Hong Kong-operated fleet to boost Asia Pacific network capacity and fuel efficiency

14 A330 freighters in total have been added to the regional network, retiring the previous A300-600F fleet This is part of DHL Express's ongoing investment to enhance its network ...

Rethinking Obesity: Novo Nordisk’s Latest Initiative Urges Singaporeans to Treat, Not Blame

“Beyond the Scale” focuses on obesity as a chronic disease — urging empathy, early intervention, and evidence-based care. SINGAPORE - Media OutReach Newswire - 27 June 2025 - Imagine a chronic dis...

Trend Micro to Deliver AI Factory with Dell and NVIDIA for Secure Infrastructure at Scale

Platforms to accelerate secure AI adoption for modern IT environments HONG KONG SAR - Media OutReach Newswire - 27 June 2025 - Trend Micro Incorporated (TYO: 4704; TSE: 4704), a global cybersecur...

HKICPA renews its Mutual Recognition Agreement with ACCA

HONG KONG SAR - Media OutReach Newswire - 27 June 2025 - The Hong Kong Institute of Certified Public Accountants (HKICPA) is delighted to announce its renewal of Mutual Recognition Agreement (MRA)...

Demand for Home Batteries surges as Federal Rebate Kicks In

A leading provider of energy solutions VoltX Energy has seen a 400% increase in demand for home batteries in the past three weeks as people put d...

Why Sport Remains the Safest Bet in an Uncertain World

When Rome was in crisis, its leaders did not retreat to the Senate. They went to the circus. To the chariot races. To the gladiators. Sport was no...

THE FINE LINE WITHIN HILARIOUS SIGNAGE DESIGN FAILS

It seems like design failures still occur in today’s modern branding era, despite rigorous rounds of approvals behind the scenes. One signage show...

Deputy Announces Exclusive Global Partnership with Predelo to Bring AI to Shift-Based Businesses

Deputy, the global people platform for shift-based businesses, has announced an exclusive partnership with Predelo, an AI Decision Agent-as-a-Serv...

Leftover Budget? The Last-Minute EOFY Tip to Drive Business Success in FY25/26

The countdown is on. With just days left until EOFY, now’s the time to make your remaining 2024–2025 budget work harder and smarter. After workin...

pay.com.au appoints new CEO and Managing Director

The former COO will lead the company’s next growth phase, with ex-CEO Edward Alder transitioning into the role of Managing Director AUSTRALIA, 25...

Sell by LayBy