Live surgeryDecember 30, 20236:57:256 speakersAvailable in: EN / IT
ICG Live Surgery #4 – Post-neoadjuvant anterior rectal resection in a patient with ulcerative colitis
Fourth ICG-School live surgery: laparoscopic anterior resection of the mid rectum in a 70-year-old man with ulcerative colitis after neoadjuvant chemoradiotherapy, with a focus on pneumoperitoneum, TNT and the TTSS technique.
Free content for members
Sign in to watch this episode
Full surgical procedures, chapter-marked discussions, and bilingual transcripts — all free for registered members.
Full episodes, chapters, and case framing
Bilingual transcripts (IT / EN)
Save favorites and resume where you left off
Clinical case
Adenocarcinoma infiltrante del retto medio insorto su rettocolite ulcerosa di lunga data
Patient framing as discussed at case introduction
SexMaschio
Age70 anni
StagecT3a N0 M0 (T2-T3 alla TC, T3a alla RM con fascia mesorettale vicina ma non infiltrata, contiguità con vescicola seminale destra)
DiagnosisAdenocarcinoma infiltrante del retto medio insorto su rettocolite ulcerosa di lunga data
Prior treatmentChemio-radioterapia neoadiuvante long course standard con capecitabina e SIB (boost a 55 Gy) + potenziamento di mesalazina. Buona risposta della componente solida; persiste componente mucinosa.
Clinical historyBMI 27, RCU quiescente seguita da gastroenterologi, pregressi polipi colici da circa 10 anni, follow-up endoscopico interrotto durante COVID. Pregressa appendicectomia ed erniorrafia bilaterale. Lieve stenosi aortica e insufficienze valvolari, pregresso tabagismo.
NotesMarcatura endoscopica con ICG a valle della lesione la mattina dell'intervento. Pelvi stretta, mesoretto ispessito post-radio, dissezione molto difficoltosa.
Overview
Fourth live surgery of the ICG school (3 November 2023) led by Gian Luca Baiocchi in Cremona with four 'Decreto Calabria' chairs (Silvia, Francesco Bonucci, Antonio, Luca Quarti). The clinical case is a 70-year-old man with long-standing ulcerative colitis and adenocarcinoma of the mid rectum cT3a N0, treated with long-course neoadjuvant chemoradiotherapy with SIB to 55 Gy and mesalazine boost, with a good response of the solid component but persistence of the mucinous component and contiguity with the right seminal vesicle.\n\nThe session integrates multidisciplinary discussion and advanced teaching: radiologist Barbara Frittoli and Ilaria Zangrandi address the role of MRI and endoanal ultrasound; radiation oncologist Marzia Filippini discusses long vs short course and SIB; medical oncologist Giulia Grizzi presents the RAPIDO, PRODIGE 23 and PROSPECT trials in detail, along with immunotherapy data (dostarlimab/pembrolizumab) in MSI-high tumors. Ferdinando Agresta delivers a structured lecture on low-pressure pneumoperitoneum (≤10 mmHg), abdominal compliance and insufflation speed.\n\nThe surgical part is particularly challenging: narrow pelvis, thickened and fragile post-radiation mesorectum, diffuse bleeding. Antonino Spinelli connects to discuss the TTSS (transanal single stapling) technique and proactive management of anastomotic leak without routine drainage; Stefano Berti contributes on trocars and 30° vs 3D optics; Paolo (Delrio) and Camillo Bertoglio offer opinions on the transanal strategy. The section is completed from above with the Medtronic radial stapler in two firings; the lesson closes with Gianluigi Moretto on the psychological management of complications, the role of the stoma therapist as case manager, and the preference for protective colostomy.
Topics
Rectal cancer diagnostics: MRI and endoanal ultrasound
Neoadjuvant therapy: long-course chemoradiotherapy vs TNT
RAPIDO, PRODIGE 23, PROSPECT trials
Immunotherapy in MSI-high colorectal tumors
Endoscopic tattooing with ICG
Low-pressure pneumoperitoneum
Mechanical and antibiotic bowel preparation
Spinelli's TTSS (transanal single stapling) technique
Mesorectal dissection and TME
Radial stapler in a narrow pelvis
Anastomotic leak management
Psychological management of complications and the role of the stoma therapist
