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Colorectal cancer (CRC) is one of the most common and fatal malignancies of the digestive system. According to the latest global cancer burden data released by the World Health Organization's International Agency for Research on Cancer (IARC) in 2020, more than 1.93 million people around the world are newly diagnosed with colorectal cancer every year, accounting for 9.7% of the world's newly diagnosed cancers, ranking 3rd in the number of male cancers and 2nd in women. In the mainland, more than 550,000 people will have new colorectal cancer in 2020, accounting for 12.2% of the number of new cancers, ranking 3rd in the number of cancer patients and 5th in mortality. 83% of colorectal cancer patients were in the middle and advanced stages when they were first diagnosed, and 44% of them had already developed metastases from the liver and lungs.
▲ In 2020, the number of cancer patients and deaths worldwide (data from the IARC official website)
▲In 2020, the number of cancer cases and deaths in China
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Recently, Professor Zheng Yun, an expert in hepatobiliary surgery at Guangzhou Taihe Cancer Hospital and Zhongshan Cancer Prevention and Control Center, performed a difficult and complex operation for a patient suffering from sigmoid colon cancer and multiple metastases of the liver.
Multidisciplinary joint diagnosis and treatment successfully defeated complex tumors
Patient Mr. Z was found to have multiple liver occurrences in the physical examination before 5 months, and after further examination in the outer hospital, he was diagnosed with sigmoid colon cancer and multiple metastases of the liver. Mr Z suffered from very severe pulmonary insufficiency and umbilical hernia due to comorbid chronic obstructive pulmonary disease. According to the recommendations of the Multi Disciplinary Team (MDT), Mr. Z completed 5 cycles of translational therapy (i.e., combination chemotherapy + targeted therapy). After treatment, Mr. Z's primary tumor lesions were withdrawn, and the liver metastatic lesions were also reduced and shrunk, which created conditions for surgical resection. Under the introduction of relatives, he came to our hospital for preoperative assessment.
▲Deputy Chief Physician Xu Hui, a gastrointestinal tumor surgery expert at Guangzhou Taihe Cancer Hospital, led the team to receive patients
After being admitted to the hospital to improve the relevant examinations, considering that Mr. Z had a history of chronic obstructive pulmonary disease complicated by extremely severe pulmonary insufficiency and umbilical hernia for many years, the Gastrointestinal Tumor Surgery Department took the lead in organizing multi-disciplinary consultations with anesthesiologists led by Peng Shulan and Director Bao Chunsen, the intensive care unit, the operating room and Professor Zheng Yun of the Cancer Prevention and Control Center of Sun Yat-sen University before the operation. The diagnosis and treatment team fully assessed the surgical risks, formulated a sound surgical plan, and finally decided to perform sigmoid colon cancer resection + partial liver metastasis resection + intraoperative ultrasound-guided cold circulation microwave ablation + umbilical hernia repair under the whole body + epidural anesthesia that retains the patient's spontaneous breathing.
Mr. Z's recent surgery went on schedule. During the operation, combined with the patient's sigmoid colon cancer with multiple liver metastases (more than 10 lesions evaluated before surgery) and umbilical hernia, the diagnosis and treatment team adopted traditional open surgery, and after umbilical herniation/repair through the mid-abdominal incision of the lower abdomen, the standard sigmoid colon cancer resection was completed.
Subsequently, Professor Zheng Yun underwent surgical treatment of liver metastases at the same time. Combined with the characteristics of patients with preoperative imaging suggesting multiple cuts and scattered liver segments of liver metastases, Professor Zheng Yun took part of the liver metastases (3) + intraoperative ultrasound-guided cold circulation microwave ablation (11 ordinary ultrasound ablation + special contrast agent sonazoid to show ablation concealment after Zhuoan contrast 3), and repeated intraoperative examinations to confirm that there was no lesion residue and no abdominal bleeding under the naked eye + ultrasound/ultrasound before ending the operation.
▲ The gastrointestinal surgery team of Guangzhou Taihe Cancer Hospital and Professor Zheng Yun, a hepatobiliary surgery expert of CUHK Cancer Prevention and Control Center, worked together to perform complex surgery for patients
After the operation, Mr. Z spent 2 days in the intensive care unit and was transferred back to the surgical ward after his condition was stable. On the 4th day after surgery, exhaust and get out of bed. After a comprehensive assessment by the doctor on the 10th day after the operation, Mr. Z recovered well in various indicators and was successfully discharged from the hospital. In addition, during Mr. Z's hospitalization, music therapist He Yinglan developed rehabilitation training for him to help improve lung function. Specific measures included interventions in neurorehabilitative music therapy, the design of musical melodies suitable for the patient's breathing exercises, and the patient instruction of Mr. Z in the ward for respiratory exercises.
▲ Xie Xiaoming, attending physician of gastrointestinal tumor surgery, and He Yinglan, a music therapist, instructed patients to perform lung function exercises
High-quality anesthesia goes all out to escort the operation
Contemporaneous surgery for colon cancer and liver metastasis itself is very demanding on anesthesia. COPD, multiple bullae with very severe pulmonary insufficiency, history of umbilical hernia... Mr. Z's own complexities are more challenging for anesthesiologists. According to Professor Peng Shulun, the chief supervisor of the Department of Anesthesiology, the patient's anesthesia diagnosis is ASA (American Association of Anesthesiologists) level III, and how to protect the patient's lungs during surgery is also a major problem.
The patient's special condition makes it clinically not permissible to administer simple general anesthesia plus relaxant as a conventional abdominal surgery. But the surgeon also needs to ensure that the muscles are loose during abdominal surgery. The anesthesia team, led by Professor Peng Shulun and Director Bao Chunsen, developed a rigorous anesthesia plan for Mr. Z to protect his lungs. They adopted general anesthesia + epidural anesthesia that preserves the patient's spontaneous breathing, which provided an important guarantee for the safe and smooth progress of the operation and laid the foundation for the success of the operation.
▲ Professor Peng Shulang, chief supervisor of the Department of Anesthesiology, and Chief Physician Bao Chunsen led the team to anesthetize the patients
Fortunately, I chose to do surgery at Guangzhou Taihe Cancer Hospital
Mr. Z is very satisfied with this experience. He said: "After the diagnosis, I went to many hospitals, but the medical staff of Guangzhou Taihe Cancer Hospital gave me family-like care and warmth. Whether it is preoperative surgical analysis or postoperative rehabilitation guidance, they are very patient and detailed, so that my family and I have a systematic and comprehensive understanding of my disease and diagnosis and treatment, and we will be more calm and active with surgery and follow-up treatment. ”
In addition to the medical skills and accompanying environment of the diagnosis and treatment team, knowing that our hospital can use medical insurance settlement, especially the door can be turned over slowly, and the medical cost is far lower than expected, Ms. L, a family member of Mr. Z, said that there is no worries about choosing Guangzhou Taihe Cancer Hospital surgery.
"As a family member, I have not slept a stable sleep since he was diagnosed, and my weight has lost more than a dozen pounds a month. And when he was preparing for major surgery this time, I slept soundly every night, and my weight did not lose at all, thanks to the superb medical skills and careful care of all the medical staff of Guangzhou Taihe Cancer Hospital, I am glad to have met such a good team." Looking back on the twists and turns of the diagnosis for more than half a year, Ms. L has repeatedly expressed her high respect and deep gratitude for the diagnosis and treatment and service of our hospital. The couple said that our hospital is the first choice for their follow-up treatment and intend to continue the postoperative related treatment in our hospital as planned.
Guangzhou Taihe Cancer Hospital, together with the Mayo Clinic, Anderson Cancer Center, Sun Yat-sen University Cancer Prevention and Treatment Center and other advanced diagnosis and treatment units at home and abroad, takes the principle of "maximizing the interests of patients", combines the disease characteristics of different tumor patients, refers to the latest comprehensive diagnosis and treatment guidelines for tumors at home and abroad, follows the multidisciplinary diagnosis and treatment orientation, formulates a standardized, individualized and precise comprehensive diagnosis and treatment plan that meets the standardization, individualization and precision of different patients, and serves every patient with a warm, responsible and caring attitude to escort the health of the general public and friends.