Halve the cases of serious complications related to colorectal cancer operations, including the need for an external stool bag, which currently occurs in one in 10 patients. A possible goal thanks to new minimally invasive surgery techniques and new methodical. For example, the one based on a fluorescent substance which, thanks to a special dedicated optical system, shows the vascularity of the edges of the intestine to be sutured to make sure that they are vascularized enough to be joined. Or thanks to a simple analysis of C-reactive protein in the blood which allows us to estimate the risk of fistulas. Furthermore, today it is known that there are also surgical maneuvers that can reduce the risks.
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The conference
The 78 centers throughout Italy that participate in the Italian study group on anastomotic fistulas in colorectal surgery – iCRAL (Italian ColoRectal Anastomotic Leakage study group), founded by Marco Catarci, Director of General Surgery at the Sandro Pertini Hospital in Rome. And it is precisely the innovations in colorectal cancer surgery that will be discussed on March 19th during the national conference “One day in Cremona with Marco Catarci” at the Cremona Hospital, promoted by RicerChiAmo Onlus and Medtronic, where the expert will give a masterful reading. Oncologists, gastroenterologists, nurses and family doctors will also participate in the conference, with a “live surgery” session, live from the operating room.
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Complications of interventions
Failure to heal the sutures leads to the appearance of fistulas, the cause of which is also poor tissue perfusion, and often forces the patient to undergo a second operation. “Serious post-operative complications occur in approximately 10% of cases – he explains Gian Luca Baiocchi, Co-Founder and Scientific Director of RicerChiAmo Onlus, Director of General Surgery of the ASST of Cremona and Full Professor of General Surgery at the University of Brescia -. The most important is the application of the stool bag, which has a devastating impact on patients’ lives, especially when it is not a temporary measure. There may also be infections of the surgical wound and its reopening, with the need for a second operation for the application of drains.”
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The impact is also high for the healthcare system, because the cost of each of these complications reaches tens of thousands of euros: “Just think that it may be necessary to prescribe antibiotics that cost 1,000 euros per day, to be taken for up to 40 days , to which are added the costs for resuscitation, equal to 2,000 euros per day, in addition to the second intervention. The cost of a surgical operation for colorectal cancer is between 7 and 10 thousand euros but, if there are complications, it exceeds 50 thousand and reaches up to 100 thousand euros”. To these figures are added indirect ones, such as the loss of working capacity.
The fluorescence technique
iCral centers have long been using the fluorescence technique, which has proven to be the most important approach, as demonstrated by a study published in BMC Surgery. In Italy, the University of Brescia and the ASST of Cremona have been the pilot centers in its use, with the establishment, in 2021, of the Permanent School of Fluorescence Guided Surgery www.icg-school.com. “The fluorescent tracer, indocyanine green, is injected intravenously in real time during the operation and enters into circulation in the patient’s blood in a very short time – explains the surgeon – The intestinal tissue becomes fluorescent, highlighting the segments in which the perfusion of blood is better. We use a special microscope with a reliability that the human eye cannot achieve.”
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The importance of C-reactive protein
Fewer complications translate into a better quality of life for patients, shorter hospitalization and faster post-operative recoveries. “In 5 years, iCral has analyzed data from over 10,000 operations from 78 centers in our country and we have published over 15 works on problems related to anastomotic fistulas – he adds Catharsis -. In addition to fluorescence, another tool capable of changing clinical practice in the early diagnosis of fistulas is the evaluation of C-reactive protein with a blood test on pre-established days after surgery. If this value remains below a certain threshold, the fistula will not develop and the patient can be discharged. Otherwise – he concludes – surveillance protocols will have to be adopted to identify it in the initial phase. Furthermore, we are conducting studies to understand whether anemia can facilitate the development of fistulas.”