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KURIKULUM VITAE

Nama

: dr. P. Sutamto Wibowo,


SpBKBD
TTL
: Bondowoso, 20 Januari 1943
Lulus dokter : thn 1967 FK UNAIR
Lulus Ahli Bedah: thn 1974 FK UNAIR
Brevet Ahli Bedah Digestif 1985 di
Surabaya
Jabatan saat ini: Staf Bag. Bedah FK
UNAIR RS dr. Soetomo Surabaya

CARCINOMA COLON
RECTUM
SURGICAL ASPECT

PAULUS SOETAMTO
WIBOWO

INCIDENCE CANCER COLON RECTUM


COUNTRIES

Australia
New Zealand
Japan
Hongkong
Singapore
China
Rep.of Korea
Malaysia
Phillipine
Vietnam
Papua New Guinea

MALES
FEMALES
ASR
65.66
74.13
60.51
60.40
44.65
29.34
15.11
40.70
22.01
29.71
15.08

Indonesia

22.000-30.000
NEW CRC/YEAR

Colon and rectal cancer age


standarized incidence
Rates per 100.000 in countries
(1990)

LOCATIONS OF CANCER COLON RECTUM


INDONESIA
LOCATION

SUMANTI WARTATMO
PHILLIPPI SUDJATMIKO
MANADO JOGJAKARTA JAKARTA SURABAYA
1990-1995
1994-1996 1991-1993

Caecum
C.Asc
C.Transv
C.Desc
Sigmoid
Rectum

3 (3.3)
9 (9.8)
5 (5.4)
10 (10.9)
15 (16.3)
50 (54.2)

TOTAL

92

3 (1.5)
8 (4.1)
41 (20.9)
144 (73.5)

196

29 (25)
11 (10)
17 (15)
23 (20)
34 (30)

8 (6.1)
13 (9.9)
3 (3.0)
12 (9.2)
12 (9.2)
53 (52.6)

114

131

SUDARSA
DENPASAR
1990-1995

5 (4.0)
8 (6.5)
5 (4.0)
6 (15.3)
19 (15.3)
81 (65.3)

124

SURVIVAL CARCINOMA COLON RECTUM

USA : 5YSR st I/II (37%)


90 %
st III
65 %
st IV
8%
SURABAYA 5YSR 50 %
SEMARANG 5YSR st I/II 70 %

RECURRENT

80 % WITHIN 2 YEARS

HEPATIC 50 %
LUNG
20 %
LOCAL
33 %
PERITONEAL SEEDING 22 %
STATISTIC USA 2001 AMERICAN CANCER SOCIETY

Colon Resection
Total

resection
Negative
proximal
distal
radial
Extended lymphadenectomy
Reanastomosis end to end

COLON RESECTION

ARTERIAL & LYMPHATIC DRAINAGE

COLON RESECTION
VENOUS DRAINAGE

COLON RESECTION

COLON RESECTION
PREOPERATIVE
NUTRITIONAL STATUS
BOWEL STERILIZATION

COLON RESECTION
RIGHT COLON :
DUODENUM
RIGHT URETER
RIGHT GONAD VESEL
LEFT COLON : LEFT URETER
LEFT GONAD VESEL
SPLEEN

END TO END ANASTOMOSE


NO TENSION

T4 --- en bloc resection


No touch technique

BOWEL OBSTRUCTION

LAVAGE INTRA OPERATIVE

LEFT COLON

IN
DOUBT

HARTMANN /
ILEOSTOMY

TME
Bladder
Penis

Prostate
Sacrum
Anus

Rectum
Coccyx

Surgical TME technique of APR

"coning in"

Cilindrical resection

CARCINOMA RECTUM

PREVENTION OF
LOCAL RECCURENCE
QUALITY OF LIFE
(SOCIAL LIFE)

MULTIMODALITY
COMBINED THERAPY
(MCT)

TOTAL MESORECTAL
EXCISION
(TME)

SPHINCTER SAVING
PROCEDURE
(STAPLES)

CARCINOMA RECTUM
TOTAL MESORECTAL EXCISION
1982 HEALD (GREAT BRITAIN)
METASTASE LATERAL (RADIAL) > DISTAL

TME

2 CM DISTAL STUMP

SPHINCTER SAVING

(FROZEN SECTION)

PRESERVE AUTONOMIC NERVE

BOWEL, BLADDER, SEXUAL FUNCTION

Norwegian Rectal Cancer Project


N = 3319
Conventional surgery

TME

Local recurrence

12%

6%

Overall survival

60%

73%

Wibe et al. Dis Colon Rectum 2002; 45:857-66

TOTAL MESORECTAL EXCISION

TOTAL MESORECTAL EXCISION

TOTAL MESORECTAL EXCISION

CARCINOMA COLON RECTUM


REANASTOMOSIS

CARCINOMA COLON RECTUM


PREOPERATIVE CHEMORADIATION
MULTIMODALITY THERAPY ?!

4-6
wks
3-6 wks

CHEMORADIATION
5FU + LEUCOVORIN
4000cGY

DOWN STAGING

RESECTABILITY
LOCAL RECURRENCE

SURGERY
CHEMORADIATION

PREOPERATIVE ASSESSMENT
OF RECTAL CANCER
ANTERIOR RESECTION

> 15 CM
10-15
CM

PARTIAL TME
CLINICAL T1 N0 M0
CLINICAL T2 N0 M0

1-10 CM

CLINICAL T3 N any M0
CLINICAL T4 N any M0

<1 CM

LOCAL EXCISION
TME
PRE-OP CHEMORADIATION
CHEMORADIATION + TME
POST-OP CHEMORADIATION
PRE-OP CHEMORADIATION +
APR
APR

CARCINOMA COLON RECTUM


FUTURE
LAPAROSCOPY
CHEMOTHERAPY
BIOMOLECULAR THERAPY
SCREENING - DIAGNOSTIC

CONCLUSION
SURGICAL AUDIT
TO IMPROVE SURVIVAL

IMPROVE SURGICAL TECHNIQUE


CHEMORADIATION PERIOPERATIVE
REFER TO A BETTER CENTRE