Shteryu Shterev

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 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