Alexander Zlatarov

By Nikola Kolev, Valentin Ignatov, Anton Tonev, Tanya Kirilova, Georgi Ivanov, Alexander Zlatarov and Krassimir Ivanov

Part of the book: Colorectal Cancer

By Valentin Ignatov, Anton Tonev, Nikola Kolev, Aleksandar Zlatarov, Shteryu Shterev, Tanya Kirilova and Krasimir Ivanov

Endoscopic submucosal dissection (ESD) was first implemented in early gastric cancer allowing for en-bloc resection of the lesions. With the experience came the expertise to introduce ESD for early colon cancer (ECC). ESD demonstrates several advantages in comparison with the endoscopic mucosa resection. It allows accurate histological assessment of the depth of invasion, minimizes the risk of local recurrence and helps in the determination of additional therapy. Indications for ESD are placed only after adequate endoscopic morphological classification of the lesions excluding higher risk of nodal metastases. This chapter provides an overview of the application of ESD techniques in ESD for ECC and provides assessment on its technical aspects and complications. In order to decrease the rate of complications a standard protocol for the ESD should be adopted. The protocol includes recommendations for patient selection, bowel and patient preparation, appropriate equipment (knives, endoscopes, and power devices). The chapter will review the current ESD techniques and oncological results. ESD could have great impact on the treatment of early colon cancer. Its role is already proven in rectal localizations and despite the challenges it should be adopted for the colon. Safe strategy for ESD is the cornerstone in decreasing complications, which includes suitable resection of specialized ESD devices.

Part of the book: Colorectal Cancer

By Nikola Kolev, Valentin Ignatov, Anton Tonev, Aleksandar Zlatarov, Boryana Naydenova, Georgi Ivanov, Dilyan Petrov and Krasimir Ivanov

Colon cancer is one of the leading malignant diseases in the Western world, leading to significant morbidity and has significant predilection for liver metastases. Synchronous metastases account for approximately 15–25% of the newly discovered liver lesions. The only curative treatment for colon cancer liver metastases (CLM) remains surgery. Several strategies have been developed for the treatment of synchronous CLM, including simultaneous resection, two-stage liver surgery, and liver-first approach. The timing of surgery is not universally determined. Even more reports support the simultaneous resection strategy with results showing similar morbidity, length of hospital stay, and perioperative mortality comparable to staged resection. In conclusion, SCLM patients can successfully be treated with simultaneous approach or stages, both having similar perioperative and long-term outcomes. With the advance of liver surgery techniques, minor and major liver surgeries can be performed safely with low morbidity and mortality as part of either a simultaneous or a staged operative strategy.

Part of the book: Colorectal Cancer

By Valentin Ignatov, Anton Tonev, Nikola Kolev, Aleksandar Zlatarov, Shteryu Shterev, Dilyan Petrov, Tanya Kirilova and Krasimir Ivanov

The minimally invasive techniques in surgical practice have been well introduced and widely accepted for certain procedures, including surgery for colon cancer. The advantages of the laparoscopic approach in terms of early and late postoperative results and the oncological safety have been established by numerous reports, including randomized controlled trials. The application of laparoscopic colon surgery for cancer has been adopted in various institutions. This chapter reviews the available literature data regarding the use of minimally invasive surgery for colon cancer, including early and late surgical and oncological results and new trends. Retrospective and prospective trials published in the last 20 years are reviewed to address the issues. Technological advantages such as intracorproreal anastomosis, single incision, and natural orifice surgery are commented in the chapter.

Part of the book: Colorectal Cancer

By Ivan Shterev Donev, Nikola Kolev, Valentin Ignatov, Anton Tonev, Aleksandar Zlatarov, Assia Konsoulova, Elitza Entcheva, Plamena Drenakova and Krasimir Ivanov

Worldwide, more than 1 million people develop colorectal cancer (CRC) annually. CRC is a major health problem in the Western world and the second most common cause of cancer mortality. To improve performance, the role of chemotherapy for CRC has increased dramatically over the last decade. The vast majority of CRC patients now receive chemotherapy with multiple agents that are currently approved for the treatment in the appropriate setting [1]. However, it is a complex process to select the optimal chemotherapy for each patient and practice evidence gap is still a problem. Some guidelines for the treatment of CRC have been developed to promote the standardization of CRC treatment. Postoperative, or “adjuvant,” systemic therapy has become standard for stage III colon cancer. Adjuvant therapy should also be strongly considered in stage II patients. It is generally recommended for any medically fit patient with stage II cancer with unfavorable factors. The hypothesis that the antitumor activity of the combination agent, including oxaliplatin, irinotecan, bevacizumab, cetuximab in metastatic cure rates, would result in increased adjuvant proved to be often wrong. Although new drug development takes years, targeted drug use can occur more quickly with advanced tests and will be a focus of future work. In addition, efforts will focus on identifying biomarkers that predict response to systemic therapy so that tailored therapy can be initiated. The future of oncology will come with the better understanding of the biology and genetics of the tumor and its host. This will help to develop tailored approach to the patients, including more specific systemic therapy, aimed at molecular targets of the malignant tumor, thus reducing the negative effects. At that time, the treatment of oncological diseases will experience a new era, comparable to the introduction of antibiotics.

Part of the book: Colorectal Cancer

By Tsvetelina Teneva, Aleksandar Zlatarov and Rozen Grigorov

In a chapter about rectal cancer there is content about rectal anatomy in relation to magnet-resonanse imaging and TME- surgery (total mesorectal excision). Secondly there is content about imaging methods used in diagnosis and follow-up of rectal cancer. Very important topic is concerning the novel imaging strategies in surgical and radiotherapy planning in the era of individual oncologic approach to the patient. At last there is detailed desctiption and metaanalysis of imaging strategies concerning neoadjuvant and adjuvant radiotherapy and chemotherapy for rectal cancer patients. All imaging markers correspond to substantial oncologic parameters such as survival rates. The connecting bridge is magnet-resonance imaging.

Part of the book: Colorectal Cancer