Conor Delaney

552 statements · 4 topics

Colorectal / ARM & Hirschsprung · guest expert Soft Tissue Sarcoma (lymph nodes) · guest expert

Featured statements

▶ Ep 207 · 19:22
if you look at the Scandinavian data, I mentioned their local recurrence rates were 27%, high 20s, when they were doing some very good rectal cancer trials. They focused on rectal cancer surgical technique and got the local recurrence rate down to under 10%. While their local recurrence rate for colon cancer was even higher than their rectal cancer local recurrence rate, because they realized they weren't doing adequate colon cancer surgery.
quote · Colorectal / ARM & Hirschsprung
▶ Ep 210 · 17:25
In Europe, it's very much gone towards five times five gray, given over five days. And then you operate about a week to two weeks later. In Europe, sorry, in the U.S., for a variety of reasons, it's a six-week, 40 to 45 gray, given with chemotherapy, staged over six weeks, and then a six-week to eight-week waiting period.
quote · Colorectal / ARM & Hirschsprung
▶ Ep 2 · 11:57
when you do an operation, and we'll come back to the neoadjuvant treatment, but when you do the operation on these patients, you've got to do it in a way that they have a negative pathological margin. If you have a negative pathological margin, the chance of local recurrence is low.
quote · Rectal Cancer
▶ Ep 4 · 10:43
if you look back in the literature for rectal cancer, local recurrence rates in series from good institutions were 20 to 38 percent and some up to 50 percent. Nowadays, really, it should be under 10 percent. And if you look at our last 10 years, Jeff, it was about 3 percent.
quote · Rectal Cancer
▶ Ep 8 · 2:03
over the last five to ten years, particularly, as we've found out more, it's become clear that these weren't actually hyperplastic, and they were really polyps that are better described as serrated adenomas.
quote · Hepatobiliary & Colorectal Surgery
▶ Ep 8 · 14:07
if you look at the historical local recurrence rates for these transanally excised rectal cancers, it was about 18%. And it was remarkably consistent across outcome data from several big centers, about 18%.
quote · Hepatobiliary & Colorectal Surgery

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Colorectal Cancer

▶ Ep 207 · 1:15
quote Colonoscopy is still very important. It's still the best test that we have. There is no perfect test, and we know that colonoscopy doesn't find every cancer, although it finds the vast majority, every polyp, although it finds the vast majority. But it's certainly the best thing we have. ↗
▶ Ep 207 · 1:15
clinical Colonoscopy is still the best test available for colon cancer detection, finding the vast majority of cancers and polyps, though not perfect. ↗
▶ Ep 207 · 2:03
quote these polyps have a really high risk of cancer, so it's very important to deal with them. ↗
▶ Ep 207 · 2:03
clinical Serrated adenomas (previously misclassified as hyperplastic polyps) have good evidence of genetic predisposition and tie into many family cancer syndromes. ↗
▶ Ep 207 · 2:03
clinical Serrated polyps have a very high risk of cancer and require family assessment to determine if patients have a family cancer syndrome. ↗
▶ Ep 207 · 2:03
quote over the last five to ten years, particularly, as we've found out more, it's become clear that these weren't actually hyperplastic, and they were really polyps that are better described as serrated adenomas. ↗
▶ Ep 207 · 3:26
clinical Serrated adenomas are often flat and difficult to see; retroflexion in the cecum is useful because they are often on the inferior or superior side of the valve or on folds. ↗
▶ Ep 207 · 4:59
clinical Six centimeters from the anal verge can be mid-rectum in a small patient (90-pound, 80-year-old female) or close to the dentate line in a large patient (6'6", 300 pounds). ↗
▶ Ep 207 · 4:59
guideline Distal margin requirements for rectal resection: 5 centimeters if possible, 2 centimeters if possible, and for very lowest tumors perhaps 1 centimeter as long as they are not poorly differentiated. ↗
▶ Ep 207 · 4:59
quote six centimeters can be a very different thing in many surgeons' minds or gastroenterologists, and it can also be a very different thing depending on the patient. ↗
▶ Ep 207 · 9:03
quote you can take out a whole rectum with about 5 mils of blood loss because it's a bloodless plane. And if you've got bleeding, you hopefully are deliberately outside of that plane, but otherwise you're in the wrong plane. ↗
▶ Ep 207 · 9:03
quote If you look back in the literature for rectal cancer, local recurrence rates in series from good institutions were 20 to 38 percent and some up to 50 percent. Nowadays, really, it should be under 10 percent. And if you look at our last 10 years, Jeff, it was about 3 percent. ↗
▶ Ep 207 · 9:03
guideline Most accepted guidelines for neoadjuvant therapy in rectal cancer are for tumors that are T3 (outside the wall of the rectum) or node positive. ↗
▶ Ep 207 · 9:03
epidemiological With optimized surgery, imaging, and patient selection, local recurrence rates for rectal cancer should be under 10 percent; Cleveland Clinic's rate over the last 10 years was about 3 percent. ↗
▶ Ep 207 · 9:03
guideline For total mesorectal excision, the circumferential resection margin should be one to two millimeters; if threatened, this is an indication for neoadjuvant therapy or extended resection. ↗
▶ Ep 207 · 9:03
clinical A total mesorectal excision can be performed with about 5 milliliters of blood loss because it is a bloodless plane; bleeding indicates being outside that plane or in the wrong plane. ↗
▶ Ep 207 · 9:03
epidemiological Historical local recurrence rates for rectal cancer from good institutions were 20 to 38 percent, with some up to 50 percent. ↗
▶ Ep 207 · 13:11
guideline For node-negative T1 or T2 rectal tumors (stage one), particularly if upper third, neoadjuvant therapy can be omitted. ↗
▶ Ep 207 · 13:18
clinical MRI is probably 90 to mid-90s percent accurate at T staging and high 80s to 90% accurate for nodal staging in rectal cancer. ↗
▶ Ep 207 · 13:18
clinical Endoscopic ultrasound is much more operator dependent and probably only 70% accurate for predicting nodal involvement in rectal cancer. ↗
▶ Ep 207 · 14:07
guideline Transanal resection is generally appropriate for tumors less than a third of the circumference, ideally less than two centimeters, that are T1. ↗
▶ Ep 207 · 14:07
epidemiological Historical local recurrence rates for transanally excised rectal cancers were about 18%, remarkably consistent across outcome data from several big centers. ↗
▶ Ep 207 · 14:07
quote if you look at the historical local recurrence rates for these transanally excised rectal cancers, it was about 18%. And it was remarkably consistent across outcome data from several big centers, about 18%. ↗
▶ Ep 207 · 14:07
opinion For young, curable patients, most surgeons favor radical resection over transanal resection; transanal resection is generally kept for patients unfit for rectal resection or those whose tumor is so close to the dentate line that a permanent stoma would be required. ↗
▶ Ep 207 · 16:23
clinical For rectal cancer, full-thickness excision is required; ESD (endoscopic submucosal dissection) would never be done for a proven cancer, only for benign polyps. ↗
▶ Ep 207 · 17:25
guideline In the U.S., long-course radiation is 40 to 45 gray given with chemotherapy over six weeks, followed by a six to eight week waiting period. ↗
▶ Ep 207 · 17:25
guideline In Europe, short-course radiation is five times five gray given over five days, with surgery about one to two weeks later. ↗
▶ Ep 207 · 17:25
quote 25 gray over a short period is equivalent to 40 to 45 over a longer period. But it can make a big difference for tumor response. ↗
▶ Ep 207 · 17:25
clinical Twenty-five gray over a short period is radiotherapeutically equivalent to 40 to 45 gray over a longer period, but longer course can make a big difference for tumor response and physical downstaging. ↗
▶ Ep 207 · 19:22
quote if you look at the Scandinavian data, I mentioned their local recurrence rates were 27%, high 20s, when they were doing some very good rectal cancer trials. They focused on rectal cancer surgical technique and got the local recurrence rate down to under 10%. While their local recurrence rate for colon cancer was even higher than their rectal cancer local recurrence rate, because they realized they weren't doing adequate colon cancer surgery. ↗
▶ Ep 207 · 19:22
guideline For colon cancer surgery, goals include at least a 5 centimeter proximal and distal margin (usually determined by blood supply) and at least 12 lymph nodes, with many surgeons hoping for at least 16. ↗
▶ Ep 207 · 19:22
clinical Total mesocolic excision should be performed in the plane between the embryological peritoneum of the retroperitoneum (Toldt's fascia) and the embryological peritoneum on the mesocolon, keeping the mesocolon complete. ↗
▶ Ep 207 · 19:22
epidemiological Scandinavian data showed local recurrence rates for colon cancer were even higher than for rectal cancer (which was high 20s percent) because they realized they weren't doing adequate colon cancer surgery. ↗
▶ Ep 207 · 22:44
guideline For a cecal tumor or lesion near the ileocecal valve, 10 centimeters of small bowel should be taken; for mid-ascending colon, 5 centimeters should be taken. ↗
▶ Ep 207 · 23:59
epidemiological Extracorporeal stapled anastomosis for right colectomy has reported leak rates of 0.8% over 1,000 cases at Cleveland Clinic. ↗
▶ Ep 207 · 24:32
guideline Genetic workup should be considered for patients with cancer under age 40, first-degree relatives with cancer, multiple cancers in a family, or non-GI cancers in a family. ↗
▶ Ep 207 · 24:32
clinical Genetic findings may change the surgical operation: a patient with a right colon cancer plus multiple polyps or significant family history may be better served with a subtotal colectomy rather than segmental resection. ↗

Colorectal Cancer

▶ Ep 209 · 1:15
quote Colonoscopy is still very important. It's still the best test that we have. There is no perfect test, and we know that colonoscopy doesn't find every cancer, although it finds the vast majority, every polyp, although it finds the vast majority. But it's certainly the best thing we have. ↗
▶ Ep 209 · 1:15
clinical Colonoscopy is still the best test available for colon cancer detection, finding the vast majority of cancers and polyps, though not perfect. ↗
▶ Ep 209 · 1:15
clinical Colonoscopy is still the best test available for colon cancer detection, finding the vast majority of cancers and polyps, though not perfect. ↗
▶ Ep 209 · 1:15
quote Colonoscopy is still very important. It's still the best test that we have. There is no perfect test, and we know that colonoscopy doesn't find every cancer, although it finds the vast majority, every polyp, although it finds the vast majority. But it's certainly the best thing we have. ↗
▶ Ep 209 · 2:03
clinical Serrated polyps have a very high risk of cancer and require family assessment to determine if patients have a family cancer syndrome. ↗
▶ Ep 209 · 2:03
clinical Serrated polyps have a very high risk of cancer and require family assessment to determine if patients have a family cancer syndrome. ↗
▶ Ep 209 · 2:03
quote these polyps have a really high risk of cancer, so it's very important to deal with them. ↗
▶ Ep 209 · 2:03
quote over the last five to ten years, particularly, as we've found out more, it's become clear that these weren't actually hyperplastic, and they were really polyps that are better described as serrated adenomas. ↗
▶ Ep 209 · 2:03
quote these polyps have a really high risk of cancer, so it's very important to deal with them. ↗
▶ Ep 209 · 2:03
quote over the last five to ten years, particularly, as we've found out more, it's become clear that these weren't actually hyperplastic, and they were really polyps that are better described as serrated adenomas. ↗
▶ Ep 209 · 2:03
clinical Serrated adenomas (previously misclassified as hyperplastic polyps) have good evidence of genetic predisposition and tie into many family cancer syndromes. ↗
▶ Ep 209 · 2:03
clinical Serrated adenomas (previously misclassified as hyperplastic polyps) have good evidence of genetic predisposition and tie into many family cancer syndromes. ↗
▶ Ep 209 · 3:26
clinical Serrated adenomas are often flat and difficult to see; retroflexion in the cecum is useful because they are often on the inferior or superior side of the valve or on folds. ↗
▶ Ep 209 · 3:26
clinical Serrated adenomas are often flat and difficult to see; retroflexion in the cecum is useful because they are often on the inferior or superior side of the valve or on folds. ↗
▶ Ep 209 · 4:59
guideline Distal margin requirements for rectal resection: 5 centimeters if possible, 2 centimeters if possible, and for very lowest tumors perhaps 1 centimeter as long as they are not poorly differentiated. ↗
▶ Ep 209 · 4:59
clinical Six centimeters from the anal verge can be mid-rectum in a small patient (90-pound, 80-year-old female) or close to the dentate line in a large patient (6'6", 300 pounds). ↗
▶ Ep 209 · 4:59
guideline Distal margin requirements for rectal resection: 5 centimeters if possible, 2 centimeters if possible, and for very lowest tumors perhaps 1 centimeter as long as they are not poorly differentiated. ↗
▶ Ep 209 · 4:59
quote six centimeters can be a very different thing in many surgeons' minds or gastroenterologists, and it can also be a very different thing depending on the patient. ↗
▶ Ep 209 · 4:59
quote six centimeters can be a very different thing in many surgeons' minds or gastroenterologists, and it can also be a very different thing depending on the patient. ↗
▶ Ep 209 · 4:59
clinical Six centimeters from the anal verge can be mid-rectum in a small patient (90-pound, 80-year-old female) or close to the dentate line in a large patient (6'6", 300 pounds). ↗
▶ Ep 209 · 9:03
quote you can take out a whole rectum with about 5 mils of blood loss because it's a bloodless plane. And if you've got bleeding, you hopefully are deliberately outside of that plane, but otherwise you're in the wrong plane. ↗
▶ Ep 209 · 9:03
quote If you look back in the literature for rectal cancer, local recurrence rates in series from good institutions were 20 to 38 percent and some up to 50 percent. Nowadays, really, it should be under 10 percent. And if you look at our last 10 years, Jeff, it was about 3 percent. ↗
▶ Ep 209 · 9:03
epidemiological Historical local recurrence rates for rectal cancer from good institutions were 20 to 38 percent, with some up to 50 percent. ↗
▶ Ep 209 · 9:03
epidemiological With optimized surgery, imaging, and patient selection, local recurrence rates for rectal cancer should be under 10 percent; Cleveland Clinic's rate over the last 10 years was about 3 percent. ↗
▶ Ep 209 · 9:03
quote you can take out a whole rectum with about 5 mils of blood loss because it's a bloodless plane. And if you've got bleeding, you hopefully are deliberately outside of that plane, but otherwise you're in the wrong plane. ↗
▶ Ep 209 · 9:03
quote If you look back in the literature for rectal cancer, local recurrence rates in series from good institutions were 20 to 38 percent and some up to 50 percent. Nowadays, really, it should be under 10 percent. And if you look at our last 10 years, Jeff, it was about 3 percent. ↗
▶ Ep 209 · 9:03
guideline For total mesorectal excision, the circumferential resection margin should be one to two millimeters; if threatened, this is an indication for neoadjuvant therapy or extended resection. ↗
▶ Ep 209 · 9:03
clinical A total mesorectal excision can be performed with about 5 milliliters of blood loss because it is a bloodless plane; bleeding indicates being outside that plane or in the wrong plane. ↗
▶ Ep 209 · 9:03
guideline Most accepted guidelines for neoadjuvant therapy in rectal cancer are for tumors that are T3 (outside the wall of the rectum) or node positive. ↗
▶ Ep 209 · 9:03
clinical A total mesorectal excision can be performed with about 5 milliliters of blood loss because it is a bloodless plane; bleeding indicates being outside that plane or in the wrong plane. ↗
▶ Ep 209 · 9:03
guideline For total mesorectal excision, the circumferential resection margin should be one to two millimeters; if threatened, this is an indication for neoadjuvant therapy or extended resection. ↗
▶ Ep 209 · 9:03
epidemiological With optimized surgery, imaging, and patient selection, local recurrence rates for rectal cancer should be under 10 percent; Cleveland Clinic's rate over the last 10 years was about 3 percent. ↗
▶ Ep 209 · 9:03
epidemiological Historical local recurrence rates for rectal cancer from good institutions were 20 to 38 percent, with some up to 50 percent. ↗
▶ Ep 209 · 9:03
guideline Most accepted guidelines for neoadjuvant therapy in rectal cancer are for tumors that are T3 (outside the wall of the rectum) or node positive. ↗
▶ Ep 209 · 13:11
guideline For node-negative T1 or T2 rectal tumors (stage one), particularly if upper third, neoadjuvant therapy can be omitted. ↗
▶ Ep 209 · 13:11
guideline For node-negative T1 or T2 rectal tumors (stage one), particularly if upper third, neoadjuvant therapy can be omitted. ↗
▶ Ep 209 · 13:18
clinical MRI is probably 90 to mid-90s percent accurate at T staging and high 80s to 90% accurate for nodal staging in rectal cancer. ↗
▶ Ep 209 · 13:18
clinical Endoscopic ultrasound is much more operator dependent and probably only 70% accurate for predicting nodal involvement in rectal cancer. ↗
▶ Ep 209 · 13:18
clinical MRI is probably 90 to mid-90s percent accurate at T staging and high 80s to 90% accurate for nodal staging in rectal cancer. ↗
▶ Ep 209 · 13:18
clinical Endoscopic ultrasound is much more operator dependent and probably only 70% accurate for predicting nodal involvement in rectal cancer. ↗
▶ Ep 209 · 14:07
opinion For young, curable patients, most surgeons favor radical resection over transanal resection; transanal resection is generally kept for patients unfit for rectal resection or those whose tumor is so close to the dentate line that a permanent stoma would be required. ↗
▶ Ep 209 · 14:07
guideline Transanal resection is generally appropriate for tumors less than a third of the circumference, ideally less than two centimeters, that are T1. ↗
▶ Ep 209 · 14:07
epidemiological Historical local recurrence rates for transanally excised rectal cancers were about 18%, remarkably consistent across outcome data from several big centers. ↗
▶ Ep 209 · 14:07
quote if you look at the historical local recurrence rates for these transanally excised rectal cancers, it was about 18%. And it was remarkably consistent across outcome data from several big centers, about 18%. ↗
▶ Ep 209 · 14:07
epidemiological Historical local recurrence rates for transanally excised rectal cancers were about 18%, remarkably consistent across outcome data from several big centers. ↗
▶ Ep 209 · 14:07
quote if you look at the historical local recurrence rates for these transanally excised rectal cancers, it was about 18%. And it was remarkably consistent across outcome data from several big centers, about 18%. ↗
▶ Ep 209 · 14:07
opinion For young, curable patients, most surgeons favor radical resection over transanal resection; transanal resection is generally kept for patients unfit for rectal resection or those whose tumor is so close to the dentate line that a permanent stoma would be required. ↗
▶ Ep 209 · 14:07
guideline Transanal resection is generally appropriate for tumors less than a third of the circumference, ideally less than two centimeters, that are T1. ↗
▶ Ep 209 · 16:23
clinical For rectal cancer, full-thickness excision is required; ESD (endoscopic submucosal dissection) would never be done for a proven cancer, only for benign polyps. ↗
▶ Ep 209 · 16:23
clinical For rectal cancer, full-thickness excision is required; ESD (endoscopic submucosal dissection) would never be done for a proven cancer, only for benign polyps. ↗
▶ Ep 209 · 17:25
guideline In the U.S., long-course radiation is 40 to 45 gray given with chemotherapy over six weeks, followed by a six to eight week waiting period. ↗
▶ Ep 209 · 17:25
quote 25 gray over a short period is equivalent to 40 to 45 over a longer period. But it can make a big difference for tumor response. ↗
▶ Ep 209 · 17:25
clinical Twenty-five gray over a short period is radiotherapeutically equivalent to 40 to 45 gray over a longer period, but longer course can make a big difference for tumor response and physical downstaging. ↗
▶ Ep 209 · 17:25
guideline In the U.S., long-course radiation is 40 to 45 gray given with chemotherapy over six weeks, followed by a six to eight week waiting period. ↗
▶ Ep 209 · 17:25
guideline In Europe, short-course radiation is five times five gray given over five days, with surgery about one to two weeks later. ↗
▶ Ep 209 · 17:25
quote 25 gray over a short period is equivalent to 40 to 45 over a longer period. But it can make a big difference for tumor response. ↗
▶ Ep 209 · 17:25
clinical Twenty-five gray over a short period is radiotherapeutically equivalent to 40 to 45 gray over a longer period, but longer course can make a big difference for tumor response and physical downstaging. ↗
▶ Ep 209 · 17:25
guideline In Europe, short-course radiation is five times five gray given over five days, with surgery about one to two weeks later. ↗
▶ Ep 209 · 19:22
clinical Total mesocolic excision should be performed in the plane between the embryological peritoneum of the retroperitoneum (Toldt's fascia) and the embryological peritoneum on the mesocolon, keeping the mesocolon complete. ↗
▶ Ep 209 · 19:22
epidemiological Scandinavian data showed local recurrence rates for colon cancer were even higher than for rectal cancer (which was high 20s percent) because they realized they weren't doing adequate colon cancer surgery. ↗
▶ Ep 209 · 19:22
epidemiological Scandinavian data showed local recurrence rates for colon cancer were even higher than for rectal cancer (which was high 20s percent) because they realized they weren't doing adequate colon cancer surgery. ↗
▶ Ep 209 · 19:22
quote if you look at the Scandinavian data, I mentioned their local recurrence rates were 27%, high 20s, when they were doing some very good rectal cancer trials. They focused on rectal cancer surgical technique and got the local recurrence rate down to under 10%. While their local recurrence rate for colon cancer was even higher than their rectal cancer local recurrence rate, because they realized they weren't doing adequate colon cancer surgery. ↗
▶ Ep 209 · 19:22
guideline For colon cancer surgery, goals include at least a 5 centimeter proximal and distal margin (usually determined by blood supply) and at least 12 lymph nodes, with many surgeons hoping for at least 16. ↗
▶ Ep 209 · 19:22
clinical Total mesocolic excision should be performed in the plane between the embryological peritoneum of the retroperitoneum (Toldt's fascia) and the embryological peritoneum on the mesocolon, keeping the mesocolon complete. ↗
▶ Ep 209 · 19:22
guideline For colon cancer surgery, goals include at least a 5 centimeter proximal and distal margin (usually determined by blood supply) and at least 12 lymph nodes, with many surgeons hoping for at least 16. ↗
▶ Ep 209 · 19:22
quote if you look at the Scandinavian data, I mentioned their local recurrence rates were 27%, high 20s, when they were doing some very good rectal cancer trials. They focused on rectal cancer surgical technique and got the local recurrence rate down to under 10%. While their local recurrence rate for colon cancer was even higher than their rectal cancer local recurrence rate, because they realized they weren't doing adequate colon cancer surgery. ↗
▶ Ep 209 · 22:44
guideline For a cecal tumor or lesion near the ileocecal valve, 10 centimeters of small bowel should be taken; for mid-ascending colon, 5 centimeters should be taken. ↗
▶ Ep 209 · 22:44
guideline For a cecal tumor or lesion near the ileocecal valve, 10 centimeters of small bowel should be taken; for mid-ascending colon, 5 centimeters should be taken. ↗
▶ Ep 209 · 23:59
epidemiological Extracorporeal stapled anastomosis for right colectomy has reported leak rates of 0.8% over 1,000 cases at Cleveland Clinic. ↗
▶ Ep 209 · 23:59
epidemiological Extracorporeal stapled anastomosis for right colectomy has reported leak rates of 0.8% over 1,000 cases at Cleveland Clinic. ↗
▶ Ep 209 · 24:32
clinical Genetic findings may change the surgical operation: a patient with a right colon cancer plus multiple polyps or significant family history may be better served with a subtotal colectomy rather than segmental resection. ↗
▶ Ep 209 · 24:32
guideline Genetic workup should be considered for patients with cancer under age 40, first-degree relatives with cancer, multiple cancers in a family, or non-GI cancers in a family. ↗
▶ Ep 209 · 24:32
guideline Genetic workup should be considered for patients with cancer under age 40, first-degree relatives with cancer, multiple cancers in a family, or non-GI cancers in a family. ↗
▶ Ep 209 · 24:32
clinical Genetic findings may change the surgical operation: a patient with a right colon cancer plus multiple polyps or significant family history may be better served with a subtotal colectomy rather than segmental resection. ↗

Colorectal Cancer

▶ Ep 210 · 1:15
quote Colonoscopy is still very important. It's still the best test that we have. There is no perfect test, and we know that colonoscopy doesn't find every cancer, although it finds the vast majority, every polyp, although it finds the vast majority. ↗
▶ Ep 210 · 1:15
quote Colonoscopy is still very important. It's still the best test that we have. There is no perfect test, and we know that colonoscopy doesn't find every cancer, although it finds the vast majority, every polyp, although it finds the vast majority. ↗
▶ Ep 210 · 1:15
clinical Colonoscopy is still the best test for colon cancer detection, with approximately 90-95% accuracy for finding cancers and polyps, though not perfect. ↗
▶ Ep 210 · 1:15
clinical Colonoscopy is still the best test for colon cancer detection, with approximately 90-95% accuracy for finding cancers and polyps, though not perfect. ↗
▶ Ep 210 · 2:03
quote these polyps have a really high risk of cancer, so it's very important to deal with them. ↗
▶ Ep 210 · 2:03
guideline Serrated adenomas require family assessment, may necessitate altered colonoscopy frequency, and family members may need colonoscopy or other testing. ↗
▶ Ep 210 · 2:03
clinical Serrated adenomas (previously misclassified as hyperplastic polyps) have a very high risk of cancer and are associated with genetic predisposition and family cancer syndromes. ↗
▶ Ep 210 · 2:03
quote these polyps have a really high risk of cancer, so it's very important to deal with them. ↗
▶ Ep 210 · 2:03
quote over the last five to ten years, particularly, as we've found out more, it's become clear that these weren't actually hyperplastic, and they were really polyps that are better described as serrated adenomas. ↗
▶ Ep 210 · 2:03
quote over the last five to ten years, particularly, as we've found out more, it's become clear that these weren't actually hyperplastic, and they were really polyps that are better described as serrated adenomas. ↗
▶ Ep 210 · 2:03
guideline Serrated adenomas require family assessment, may necessitate altered colonoscopy frequency, and family members may need colonoscopy or other testing. ↗
▶ Ep 210 · 2:03
clinical Serrated adenomas (previously misclassified as hyperplastic polyps) have a very high risk of cancer and are associated with genetic predisposition and family cancer syndromes. ↗
▶ Ep 210 · 3:26
clinical Serrated polyps are often flat and difficult to see; retroflexion in the cecum is useful because they are often on the inferior or superior side of the valve or on folds. ↗
▶ Ep 210 · 3:26
clinical Serrated polyps are often flat and difficult to see; retroflexion in the cecum is useful because they are often on the inferior or superior side of the valve or on folds. ↗
▶ Ep 210 · 4:59
clinical Six centimeters from the anal verge can mean different things depending on patient size: in a small elderly female it may be mid-rectum, while in a large male it can be near the dentate line. ↗
▶ Ep 210 · 4:59
guideline For rectal cancer, distal margin requirements are 5 cm if achievable, 2 cm if achievable, and for very low tumors 1 cm is acceptable as long as they are not poorly differentiated. ↗
▶ Ep 210 · 4:59
clinical Six centimeters from the anal verge can mean different things depending on patient size: in a small elderly female it may be mid-rectum, while in a large male it can be near the dentate line. ↗
▶ Ep 210 · 4:59
quote 6 centimeters in a 90-pound, 80-year-old female can be almost mid-rectum. 6 centimeters in a guy who's 6'6 and 300 pounds can be the top of the anal canal or even close to the dentate line. ↗
▶ Ep 210 · 4:59
quote your distal margin needs to be 5 centimeters if you can get it, 2 centimeters if you can get it, and for the very lowest tumors, perhaps 1 centimeter as long as they're not poorly differentiated. ↗
▶ Ep 210 · 4:59
guideline For rectal cancer, distal margin requirements are 5 cm if achievable, 2 cm if achievable, and for very low tumors 1 cm is acceptable as long as they are not poorly differentiated. ↗
▶ Ep 210 · 4:59
quote 6 centimeters in a 90-pound, 80-year-old female can be almost mid-rectum. 6 centimeters in a guy who's 6'6 and 300 pounds can be the top of the anal canal or even close to the dentate line. ↗
▶ Ep 210 · 4:59
quote your distal margin needs to be 5 centimeters if you can get it, 2 centimeters if you can get it, and for the very lowest tumors, perhaps 1 centimeter as long as they're not poorly differentiated. ↗
▶ Ep 210 · 6:51
clinical Upper third rectal cancers likely do not need preoperative therapy or stoma, while middle and lower third cancers have a good chance of needing neoadjuvant therapy and temporary or rarely permanent stoma. ↗
▶ Ep 210 · 6:51
clinical Upper third rectal cancers likely do not need preoperative therapy or stoma, while middle and lower third cancers have a good chance of needing neoadjuvant therapy and temporary or rarely permanent stoma. ↗
▶ Ep 210 · 9:03
guideline Distant staging for rectal cancer is best done with CT abdomen for liver assessment and CT chest (now preferred over chest x-ray per most guidelines). ↗
▶ Ep 210 · 9:03
guideline MRI with high-resolution, high Tesla magnet and standardized protocol (developed by Bill Heald and Gina Brown at Royal Marsden) is now the standard for local staging of rectal cancer. ↗
▶ Ep 210 · 9:03
guideline MRI with high-resolution, high Tesla magnet and standardized protocol (developed by Bill Heald and Gina Brown at Royal Marsden) is now the standard for local staging of rectal cancer. ↗
▶ Ep 210 · 9:03
guideline Distant staging for rectal cancer is best done with CT abdomen for liver assessment and CT chest (now preferred over chest x-ray per most guidelines). ↗
▶ Ep 210 · 10:43
quote when you do an operation on these patients, you've got to do it in a way that they have a negative pathological margin. If you have a negative pathological margin, the chance of local recurrence is low. ↗
▶ Ep 210 · 10:43
epidemiological Cleveland Clinic's local recurrence rate for rectal cancer over the last 10 years was approximately 3%. ↗
▶ Ep 210 · 10:43
quote you can take out a whole rectum with about 5 mils of blood loss because it's a bloodless plane. And if you've got bleeding, you hopefully are deliberately outside of that plane, but otherwise you're in the wrong plane. ↗
▶ Ep 210 · 10:43
epidemiological Historical local recurrence rates for rectal cancer from good institutions were 20-38%, with some up to 50%, but with optimized surgery and imaging should now be under 10%. ↗
▶ Ep 210 · 10:43
quote when you do an operation on these patients, you've got to do it in a way that they have a negative pathological margin. If you have a negative pathological margin, the chance of local recurrence is low. ↗
▶ Ep 210 · 10:43
clinical MRI is approximately 90-95% accurate for T staging and high 80s to 90% accurate for nodal staging in rectal cancer. ↗
▶ Ep 210 · 10:43
clinical Total mesorectal excision (TME) can be performed with about 5 mL of blood loss because it is a bloodless plane; bleeding indicates being outside that plane or deliberately in the wrong plane. ↗
▶ Ep 210 · 10:43
clinical Circumferential resection margin is the most important margin in rectal cancer surgery; a negative pathological margin results in low chance of local recurrence. ↗
▶ Ep 210 · 10:43
epidemiological Cleveland Clinic's local recurrence rate for rectal cancer over the last 10 years was approximately 3%. ↗
▶ Ep 210 · 10:43
epidemiological Historical local recurrence rates for rectal cancer from good institutions were 20-38%, with some up to 50%, but with optimized surgery and imaging should now be under 10%. ↗
▶ Ep 210 · 10:43
quote if you look back in the literature for rectal cancer, local recurrence rates in series from good institutions were 20 to 38 percent and some up to 50 percent. Nowadays, really, it should be under 10 percent. And if you look at our last 10 years, Jeff, it was about 3 percent. ↗
▶ Ep 210 · 10:43
clinical MRI is approximately 90-95% accurate for T staging and high 80s to 90% accurate for nodal staging in rectal cancer. ↗
▶ Ep 210 · 10:43
clinical Total mesorectal excision (TME) can be performed with about 5 mL of blood loss because it is a bloodless plane; bleeding indicates being outside that plane or deliberately in the wrong plane. ↗
▶ Ep 210 · 10:43
clinical Circumferential resection margin is the most important margin in rectal cancer surgery; a negative pathological margin results in low chance of local recurrence. ↗
▶ Ep 210 · 10:43
quote you can take out a whole rectum with about 5 mils of blood loss because it's a bloodless plane. And if you've got bleeding, you hopefully are deliberately outside of that plane, but otherwise you're in the wrong plane. ↗
▶ Ep 210 · 10:43
quote if you look back in the literature for rectal cancer, local recurrence rates in series from good institutions were 20 to 38 percent and some up to 50 percent. Nowadays, really, it should be under 10 percent. And if you look at our last 10 years, Jeff, it was about 3 percent. ↗
▶ Ep 210 · 13:11
quote Ultrasound is much more operator dependent, and it's probably only 70% accurate for predicting nodal involvement. ↗
▶ Ep 210 · 13:11
clinical Endoscopic ultrasound is only about 70% accurate for predicting nodal involvement in rectal cancer and is much more operator dependent than MRI. ↗
▶ Ep 210 · 13:11
clinical Endoscopic ultrasound is only about 70% accurate for predicting nodal involvement in rectal cancer and is much more operator dependent than MRI. ↗
▶ Ep 210 · 13:11
guideline Neoadjuvant therapy is indicated for rectal tumors that are T3 (outside the wall) or node positive. ↗
▶ Ep 210 · 13:11
guideline Stage I rectal cancer (node negative and T1 or T2), particularly if upper third, does not require preoperative radiation. ↗
▶ Ep 210 · 13:11
guideline Neoadjuvant therapy is indicated for rectal tumors that are T3 (outside the wall) or node positive. ↗
▶ Ep 210 · 13:11
guideline Stage I rectal cancer (node negative and T1 or T2), particularly if upper third, does not require preoperative radiation. ↗
▶ Ep 210 · 13:11
quote MRI is probably 90 to mid 90s accurate at T staging, and it's probably high 80s to 90% accurate for nodal staging. ↗
▶ Ep 210 · 13:11
quote Ultrasound is much more operator dependent, and it's probably only 70% accurate for predicting nodal involvement. ↗
▶ Ep 210 · 13:11
quote MRI is probably 90 to mid 90s accurate at T staging, and it's probably high 80s to 90% accurate for nodal staging. ↗
▶ Ep 210 · 14:07
quote if you look at the historical local recurrence rates for these transanally excised rectal cancers, it was about 18%. And it was remarkably consistent across outcome data from several big centers, about 18%. ↗
▶ Ep 210 · 14:07
quote if you look at the historical local recurrence rates for these transanally excised rectal cancers, it was about 18%. And it was remarkably consistent across outcome data from several big centers, about 18%. ↗
▶ Ep 210 · 14:07
opinion For young, curable patients, radical resection is generally favored over transanal resection; transanal approaches are reserved for patients unfit for rectal resection or those whose tumor location would require permanent stoma. ↗
▶ Ep 210 · 14:07
guideline Transanal resection is appropriate for tumors less than one-third circumference, ideally less than 2 cm, that are T1. ↗
▶ Ep 210 · 14:07
epidemiological Historical local recurrence rates for transanally excised rectal cancers were approximately 18%, remarkably consistent across several major centers. ↗
▶ Ep 210 · 14:07
opinion For young, curable patients, radical resection is generally favored over transanal resection; transanal approaches are reserved for patients unfit for rectal resection or those whose tumor location would require permanent stoma. ↗
▶ Ep 210 · 14:07
guideline Transanal resection is appropriate for tumors less than one-third circumference, ideally less than 2 cm, that are T1. ↗
▶ Ep 210 · 14:07
epidemiological Historical local recurrence rates for transanally excised rectal cancers were approximately 18%, remarkably consistent across several major centers. ↗
▶ Ep 210 · 15:58
guideline Rectal cancer requires full-thickness excision; endoscopic submucosal dissection (ESD) would never be used for proven or high-risk cancer, only for benign polyps. ↗
▶ Ep 210 · 15:58
guideline Rectal cancer requires full-thickness excision; endoscopic submucosal dissection (ESD) would never be used for proven or high-risk cancer, only for benign polyps. ↗
▶ Ep 210 · 16:23
quote if it's a rectal cancer, it needs to be a full thickness excision. So you would never do an ESD type procedure. ↗
▶ Ep 210 · 16:23
quote if it's a rectal cancer, it needs to be a full thickness excision. So you would never do an ESD type procedure. ↗
▶ Ep 210 · 17:25
guideline Short-course radiation (5×5 Gy over 5 days, surgery 1-2 weeks later) is preferred in Europe, while long-course chemoradiation (40-45 Gy over 6 weeks with 6-8 week wait) is preferred in the U.S. ↗
▶ Ep 210 · 17:25
quote In Europe, it's very much gone towards five times five gray, given over five days. And then you operate about a week to two weeks later. In Europe, sorry, in the U.S., for a variety of reasons, it's a six-week, 40 to 45 gray, given with chemotherapy, staged over six weeks, and then a six-week to eight-week waiting period. ↗
▶ Ep 210 · 17:25
quote In Europe, it's very much gone towards five times five gray, given over five days. And then you operate about a week to two weeks later. In Europe, sorry, in the U.S., for a variety of reasons, it's a six-week, 40 to 45 gray, given with chemotherapy, staged over six weeks, and then a six-week to eight-week waiting period. ↗
▶ Ep 210 · 17:25
guideline Short-course radiation (5×5 Gy over 5 days, surgery 1-2 weeks later) is preferred in Europe, while long-course chemoradiation (40-45 Gy over 6 weeks with 6-8 week wait) is preferred in the U.S. ↗
▶ Ep 210 · 17:25
clinical 25 Gy over a short period is radiotherapeutically equivalent to 40-45 Gy over a longer period, but long-course therapy produces greater tumor downstaging and is preferred for bulky tumors. ↗
▶ Ep 210 · 17:25
clinical 25 Gy over a short period is radiotherapeutically equivalent to 40-45 Gy over a longer period, but long-course therapy produces greater tumor downstaging and is preferred for bulky tumors. ↗
▶ Ep 210 · 19:22
clinical High ligation of the inferior mesenteric artery (above the takeoff of the left colic artery) is performed in sigmoid colectomy, with protection of autonomic nerves to preserve sexual function. ↗
▶ Ep 210 · 19:22
clinical Total mesocolic excision should be performed in the plane between Toltz fascia (retroperitoneal embryological peritoneum) and the mesocolon peritoneum, achieving complete mesocolic specimen with minimal blood loss. ↗
▶ Ep 210 · 19:22
clinical Total mesocolic excision should be performed in the plane between Toltz fascia (retroperitoneal embryological peritoneum) and the mesocolon peritoneum, achieving complete mesocolic specimen with minimal blood loss. ↗
▶ Ep 210 · 19:22
epidemiological Scandinavian data showed local recurrence rates for colon cancer were higher than for rectal cancer (despite rectal rates of high 20s) because adequate colon cancer surgery technique was not being performed. ↗
▶ Ep 210 · 19:22
epidemiological Scandinavian data showed local recurrence rates for colon cancer were higher than for rectal cancer (despite rectal rates of high 20s) because adequate colon cancer surgery technique was not being performed. ↗
▶ Ep 210 · 19:22
guideline For colon cancer, surgeons should aim for at least 12 lymph nodes, though many hope for at least 16. ↗
▶ Ep 210 · 19:22
clinical High ligation of the inferior mesenteric artery (above the takeoff of the left colic artery) is performed in sigmoid colectomy, with protection of autonomic nerves to preserve sexual function. ↗
▶ Ep 210 · 19:22
guideline For colon cancer, surgeons should aim for at least 12 lymph nodes, though many hope for at least 16. ↗
▶ Ep 210 · 21:23
clinical For mid-sigmoid cancer (35-40 cm), resection can extend from mid-descending colon to rectosigmoid junction without necessarily taking the splenic flexure, provided there is good vascularity with pulsatile flow. ↗
▶ Ep 210 · 21:23
clinical For mid-sigmoid cancer (35-40 cm), resection can extend from mid-descending colon to rectosigmoid junction without necessarily taking the splenic flexure, provided there is good vascularity with pulsatile flow. ↗
▶ Ep 210 · 22:44
guideline For cecal tumors, 10 cm of small bowel should be taken; for mid-ascending colon tumors, 5 cm of small bowel is adequate. ↗
▶ Ep 210 · 22:44
guideline For cecal tumors, 10 cm of small bowel should be taken; for mid-ascending colon tumors, 5 cm of small bowel is adequate. ↗
▶ Ep 210 · 23:55
epidemiological Extracorporeal stapled anastomosis through the extraction site for laparoscopic right colectomy has achieved leak rates of 0.8% over 1,000 cases at Cleveland Clinic. ↗
▶ Ep 210 · 23:55
epidemiological Extracorporeal stapled anastomosis through the extraction site for laparoscopic right colectomy has achieved leak rates of 0.8% over 1,000 cases at Cleveland Clinic. ↗
▶ Ep 210 · 24:32
clinical Cleveland Clinic has a low threshold for genetic assessment, consulting coordinators when patients meet Bethesda criteria, have first-degree relatives with cancer, young family members with cancer, or multiple cancers in the family. ↗
▶ Ep 210 · 24:32
clinical Genetic diagnosis may change the surgical approach: patients with multiple polyps or significant family history may be better served with subtotal colectomy (ileosigmoid or ileorectal anastomosis) rather than segmental resection. ↗
▶ Ep 210 · 24:32
clinical Genetic diagnosis may change the surgical approach: patients with multiple polyps or significant family history may be better served with subtotal colectomy (ileosigmoid or ileorectal anastomosis) rather than segmental resection. ↗
▶ Ep 210 · 24:32
clinical Cleveland Clinic has a low threshold for genetic assessment, consulting coordinators when patients meet Bethesda criteria, have first-degree relatives with cancer, young family members with cancer, or multiple cancers in the family. ↗
Conor's statements about Hepatobiliary & Colorectal Surgery 37 statements

Open the Hepatobiliary & Colorectal Surgery collection →

Colorectal Cancer

▶ Ep 8 · 1:15
quote Colonoscopy is still very important. It's still the best test that we have. There is no perfect test, and we know that colonoscopy doesn't find every cancer, although it finds the vast majority, every polyp, although it finds the vast majority. But it's certainly the best thing we have. ↗
▶ Ep 8 · 1:15
clinical Colonoscopy is still the best test available for colon cancer detection, finding the vast majority of cancers and polyps, though not perfect. ↗
▶ Ep 8 · 2:03
quote over the last five to ten years, particularly, as we've found out more, it's become clear that these weren't actually hyperplastic, and they were really polyps that are better described as serrated adenomas. ↗
▶ Ep 8 · 2:03
clinical Serrated polyps have a very high risk of cancer and require family assessment to determine if patients have a family cancer syndrome. ↗
▶ Ep 8 · 2:03
clinical Serrated adenomas (previously misclassified as hyperplastic polyps) have good evidence of genetic predisposition and tie into many family cancer syndromes. ↗
▶ Ep 8 · 2:03
quote these polyps have a really high risk of cancer, so it's very important to deal with them. ↗
▶ Ep 8 · 3:26
clinical Serrated adenomas are often flat and difficult to see; retroflexion in the cecum is useful because they are often on the inferior or superior side of the valve or on folds. ↗
▶ Ep 8 · 4:59
guideline Distal margin requirements for rectal resection: 5 centimeters if possible, 2 centimeters if possible, and for very lowest tumors perhaps 1 centimeter as long as they are not poorly differentiated. ↗
▶ Ep 8 · 4:59
clinical Six centimeters from the anal verge can be mid-rectum in a small patient (90-pound, 80-year-old female) or close to the dentate line in a large patient (6'6", 300 pounds). ↗
▶ Ep 8 · 4:59
quote six centimeters can be a very different thing in many surgeons' minds or gastroenterologists, and it can also be a very different thing depending on the patient. ↗
▶ Ep 8 · 9:03
guideline Most accepted guidelines for neoadjuvant therapy in rectal cancer are for tumors that are T3 (outside the wall of the rectum) or node positive. ↗
▶ Ep 8 · 9:03
quote you can take out a whole rectum with about 5 mils of blood loss because it's a bloodless plane. And if you've got bleeding, you hopefully are deliberately outside of that plane, but otherwise you're in the wrong plane. ↗
▶ Ep 8 · 9:03
quote If you look back in the literature for rectal cancer, local recurrence rates in series from good institutions were 20 to 38 percent and some up to 50 percent. Nowadays, really, it should be under 10 percent. And if you look at our last 10 years, Jeff, it was about 3 percent. ↗
▶ Ep 8 · 9:03
clinical A total mesorectal excision can be performed with about 5 milliliters of blood loss because it is a bloodless plane; bleeding indicates being outside that plane or in the wrong plane. ↗
▶ Ep 8 · 9:03
guideline For total mesorectal excision, the circumferential resection margin should be one to two millimeters; if threatened, this is an indication for neoadjuvant therapy or extended resection. ↗
▶ Ep 8 · 9:03
epidemiological With optimized surgery, imaging, and patient selection, local recurrence rates for rectal cancer should be under 10 percent; Cleveland Clinic's rate over the last 10 years was about 3 percent. ↗
▶ Ep 8 · 9:03
epidemiological Historical local recurrence rates for rectal cancer from good institutions were 20 to 38 percent, with some up to 50 percent. ↗
▶ Ep 8 · 13:11
guideline For node-negative T1 or T2 rectal tumors (stage one), particularly if upper third, neoadjuvant therapy can be omitted. ↗
▶ Ep 8 · 13:18
clinical Endoscopic ultrasound is much more operator dependent and probably only 70% accurate for predicting nodal involvement in rectal cancer. ↗
▶ Ep 8 · 13:18
clinical MRI is probably 90 to mid-90s percent accurate at T staging and high 80s to 90% accurate for nodal staging in rectal cancer. ↗
▶ Ep 8 · 14:07
opinion For young, curable patients, most surgeons favor radical resection over transanal resection; transanal resection is generally kept for patients unfit for rectal resection or those whose tumor is so close to the dentate line that a permanent stoma would be required. ↗
▶ Ep 8 · 14:07
guideline Transanal resection is generally appropriate for tumors less than a third of the circumference, ideally less than two centimeters, that are T1. ↗
▶ Ep 8 · 14:07
epidemiological Historical local recurrence rates for transanally excised rectal cancers were about 18%, remarkably consistent across outcome data from several big centers. ↗
▶ Ep 8 · 14:07
quote if you look at the historical local recurrence rates for these transanally excised rectal cancers, it was about 18%. And it was remarkably consistent across outcome data from several big centers, about 18%. ↗
▶ Ep 8 · 16:23
clinical For rectal cancer, full-thickness excision is required; ESD (endoscopic submucosal dissection) would never be done for a proven cancer, only for benign polyps. ↗
▶ Ep 8 · 17:25
clinical Twenty-five gray over a short period is radiotherapeutically equivalent to 40 to 45 gray over a longer period, but longer course can make a big difference for tumor response and physical downstaging. ↗
▶ Ep 8 · 17:25
quote 25 gray over a short period is equivalent to 40 to 45 over a longer period. But it can make a big difference for tumor response. ↗
▶ Ep 8 · 17:25
guideline In the U.S., long-course radiation is 40 to 45 gray given with chemotherapy over six weeks, followed by a six to eight week waiting period. ↗
▶ Ep 8 · 17:25
guideline In Europe, short-course radiation is five times five gray given over five days, with surgery about one to two weeks later. ↗
▶ Ep 8 · 19:22
guideline For colon cancer surgery, goals include at least a 5 centimeter proximal and distal margin (usually determined by blood supply) and at least 12 lymph nodes, with many surgeons hoping for at least 16. ↗
▶ Ep 8 · 19:22
epidemiological Scandinavian data showed local recurrence rates for colon cancer were even higher than for rectal cancer (which was high 20s percent) because they realized they weren't doing adequate colon cancer surgery. ↗
▶ Ep 8 · 19:22
quote if you look at the Scandinavian data, I mentioned their local recurrence rates were 27%, high 20s, when they were doing some very good rectal cancer trials. They focused on rectal cancer surgical technique and got the local recurrence rate down to under 10%. While their local recurrence rate for colon cancer was even higher than their rectal cancer local recurrence rate, because they realized they weren't doing adequate colon cancer surgery. ↗
▶ Ep 8 · 19:22
clinical Total mesocolic excision should be performed in the plane between the embryological peritoneum of the retroperitoneum (Toldt's fascia) and the embryological peritoneum on the mesocolon, keeping the mesocolon complete. ↗
▶ Ep 8 · 22:44
guideline For a cecal tumor or lesion near the ileocecal valve, 10 centimeters of small bowel should be taken; for mid-ascending colon, 5 centimeters should be taken. ↗
▶ Ep 8 · 23:59
epidemiological Extracorporeal stapled anastomosis for right colectomy has reported leak rates of 0.8% over 1,000 cases at Cleveland Clinic. ↗
▶ Ep 8 · 24:32
clinical Genetic findings may change the surgical operation: a patient with a right colon cancer plus multiple polyps or significant family history may be better served with a subtotal colectomy rather than segmental resection. ↗
▶ Ep 8 · 24:32
guideline Genetic workup should be considered for patients with cancer under age 40, first-degree relatives with cancer, multiple cancers in a family, or non-GI cancers in a family. ↗
Conor's statements about Rectal Cancer 276 statements

Open the Rectal Cancer collection →

Colon Cancer with Conor Delaney

▶ Ep 2 · 1:16
quote colonoscopy is still very important. It's still the best test that we have. There is no perfect test, and we know that colonoscopy doesn't find every cancer, although it finds the vast majority, every polyp, although it finds the vast majority, but it's certainly the best thing we have ↗
▶ Ep 2 · 1:16
clinical Colonoscopy is still the best test for colon cancer detection, finding the vast majority of cancers and polyps, though not perfect. ↗
▶ Ep 2 · 2:05
clinical Serrated adenomas (previously misclassified as hyperplastic polyps, particularly large ones in the right colon) have genetic predisposition, tie into family cancer syndromes, and carry very high cancer risk. ↗
▶ Ep 2 · 2:38
quote these polyps have a really high risk of cancer. So it's very important to deal with them, but third is that it's very important to be able to tell the patient that they're at higher risk ↗
▶ Ep 2 · 2:42
guideline Finding serrated adenomas requires family assessment for hereditary cancer syndromes and may necessitate changes in colonoscopy frequency and family member screening. ↗
▶ Ep 2 · 3:27
clinical Serrated polyps can be flat and difficult to visualize; retroflexion in the cecum is increasingly used because they are often on the inferior or superior side of folds. ↗
▶ Ep 2 · 6:13
clinical For rectal cancer, distal margin requirements are 5 cm if achievable, 2 cm if necessary, and 1 cm for very low tumors as long as they are not poorly differentiated. ↗
▶ Ep 2 · 7:25
clinical The measurement '6 centimeters from the anal verge' varies significantly by patient body habitus and can represent different anatomical locations (anorectal ring vs. near dentate line). ↗
▶ Ep 2 · 8:01
quote 6 centimeters doesn't mean 6 centimeters. It's not the same to everybody and it's not the same to every patient. ↗
▶ Ep 2 · 9:31
guideline Distant staging for rectal cancer is best performed with CT abdomen (for liver metastases) and CT chest (replacing chest X-ray per current guidelines). ↗
▶ Ep 2 · 9:50
clinical MRI has become the standard for local staging of rectal cancer, with high-resolution, high-Tesla magnets using standardized protocols developed by Bill Heald and Gina Brown at the Royal Marsden. ↗
▶ Ep 2 · 10:27
clinical MRI is particularly good at distinguishing T3 and T4 tumors and assessing circumferential resection margins, though less accurate at distinguishing T1 from T2. ↗
▶ Ep 2 · 10:39
clinical Circumferential resection margin is the most important margin (or many think more important than distal margin) for preventing local recurrence in rectal cancer. ↗
▶ Ep 2 · 10:51
epidemiological Historical local recurrence rates for rectal cancer from good institutions were 20–38%, with some series up to 50%. ↗
▶ Ep 2 · 10:51
quote if you look back in the literature for rectal cancer. Local recurrence rates in series from good institutions were 20 to 38% and some up to 50%. Nowadays, really it should be under 10%, and if you look at our last 10 years, Jeff, it was about 3%. ↗
▶ Ep 2 · 11:04
epidemiological With optimized surgery and imaging, local recurrence rates for rectal cancer should now be under 10%; Cleveland Clinic's rate over the last 10 years was about 3%. ↗
▶ Ep 2 · 11:57
quote when you do an operation, and we'll come back to the neoadjuvant treatment, but when you do the operation on these patients, you've got to do it in a way that they have a negative pathological margin. If you have a negative pathological margin, the chance of local recurrence is low. ↗
▶ Ep 2 · 12:24
clinical Total mesorectal excision (TME) can be performed with about 5 mL of blood loss because it follows a bloodless embryological plane; bleeding indicates wrong plane unless deliberately outside TME plane. ↗
▶ Ep 2 · 12:24
quote you can take out a whole rectum with about 5 mL of blood loss because it's a bloodless plane. And if you've got bleeding, you hopefully are deliberately outside of that plane, but otherwise you're in the wrong plane. ↗
▶ Ep 2 · 12:54
guideline Neoadjuvant therapy for rectal cancer is indicated for T3 tumors (outside the rectal wall) or node-positive disease. ↗
▶ Ep 2 · 13:18
guideline Stage 1 rectal cancer (node-negative, T1 or T2), particularly in the upper third of the rectum, does not require neoadjuvant therapy. ↗
▶ Ep 2 · 13:37
clinical MRI is 90 to mid-90s percent accurate for T-staging and high 80s to 90% accurate for nodal staging of rectal cancer. ↗
▶ Ep 2 · 13:56
clinical Endoscopic ultrasound is only about 70% accurate for predicting nodal involvement in rectal cancer and is much more operator-dependent than MRI. ↗
▶ Ep 2 · 14:35
guideline Transanal resection for rectal cancer is generally limited to T1 tumors less than one-third circumference and ideally less than 2 cm. ↗
▶ Ep 2 · 14:51
epidemiological Historical local recurrence rates for transanally excised rectal cancers were about 18%, remarkably consistent across multiple centers. ↗
▶ Ep 2 · 15:05
opinion Transanal endoscopic microsurgery (TEM) may produce better outcomes than traditional transanal excision, though it is unclear whether this is due to technology or improved surgical understanding. ↗
▶ Ep 2 · 15:27
guideline For young, curable patients, radical resection is generally favored over transanal resection; transanal resection is typically reserved for patients unfit for radical surgery or those who would require permanent stoma. ↗
▶ Ep 2 · 16:24
clinical For rectal cancer, full-thickness excision is required; ESD or EMR is never appropriate for proven cancer, only for benign polyps. ↗
▶ Ep 2 · 18:04
guideline Short-course radiation (5×5 Gy over 5 days, surgery 1–2 weeks later) is commonly used in Europe; long-course chemoradiation (40–45 Gy over 6 weeks with 6–8 week wait) is standard in the US. ↗
▶ Ep 2 · 18:26
clinical 25 Gy over a short period is radiotherapeutically equivalent to 40–45 Gy over a longer period, but long-course therapy may produce better tumor downstaging for bulky tumors. ↗
▶ Ep 2 · 19:51
guideline For colon cancer, at least 12 lymph nodes are required for adequate staging, though many surgeons aim for at least 16. ↗
▶ Ep 2 · 19:59
clinical High ligation of the inferior mesenteric artery (above the takeoff of the left colic artery) is standard for sigmoid colectomy, with protection of autonomic nerves to preserve sexual function. ↗
▶ Ep 2 · 20:18
clinical Total mesocolic excision for colon cancer should be performed with about 5 mL of blood loss in the embryological plane between retroperitoneal peritoneum (Toldt's fascia) and mesocolic peritoneum. ↗
▶ Ep 2 · 20:48
epidemiological Scandinavian data showed local recurrence rates for colon cancer were even higher than for rectal cancer (high 20s%) before focus on complete mesocolic excision technique. ↗
▶ Ep 2 · 23:12
clinical For cecal or ileocecal valve tumors, 10 cm of small bowel should be resected; for mid-ascending colon tumors, 5 cm of small bowel is adequate. ↗
▶ Ep 2 · 24:00
epidemiological Extracorporeal stapled anastomosis for right hemicolectomy achieved a leak rate of 0.8% over 1000 cases at Cleveland Clinic. ↗
▶ Ep 2 · 24:56
guideline Genetic assessment is indicated for colorectal cancer patients with Bethesda criteria risk factors, cancer under age 40, first-degree relatives with cancer, or multiple cancers in the family. ↗
▶ Ep 2 · 25:33
clinical Genetic diagnosis affects both family screening recommendations and surgical approach; patients with hereditary syndromes may require subtotal colectomy or proctocolectomy rather than segmental resection. ↗

Colorectal Cancer

▶ Ep 2 · 1:15
clinical Colonoscopy is still the best test available for colon cancer detection, finding the vast majority of cancers and polyps, though not perfect. ↗
▶ Ep 2 · 1:15
quote Colonoscopy is still very important. It's still the best test that we have. There is no perfect test, and we know that colonoscopy doesn't find every cancer, although it finds the vast majority, every polyp, although it finds the vast majority. But it's certainly the best thing we have. ↗
▶ Ep 2 · 1:15
clinical Colonoscopy is still the best test available for colon cancer detection, finding the vast majority of cancers and polyps, though not perfect. ↗
▶ Ep 2 · 1:15
quote Colonoscopy is still very important. It's still the best test that we have. There is no perfect test, and we know that colonoscopy doesn't find every cancer, although it finds the vast majority, every polyp, although it finds the vast majority. But it's certainly the best thing we have. ↗
▶ Ep 2 · 2:03
clinical Serrated adenomas (previously misclassified as hyperplastic polyps) have good evidence of genetic predisposition and tie into many family cancer syndromes. ↗
▶ Ep 2 · 2:03
quote over the last five to ten years, particularly, as we've found out more, it's become clear that these weren't actually hyperplastic, and they were really polyps that are better described as serrated adenomas. ↗
▶ Ep 2 · 2:03
clinical Serrated polyps have a very high risk of cancer and require family assessment to determine if patients have a family cancer syndrome. ↗
▶ Ep 2 · 2:03
clinical Serrated adenomas (previously misclassified as hyperplastic polyps) have good evidence of genetic predisposition and tie into many family cancer syndromes. ↗
▶ Ep 2 · 2:03
quote these polyps have a really high risk of cancer, so it's very important to deal with them. ↗
▶ Ep 2 · 2:03
clinical Serrated polyps have a very high risk of cancer and require family assessment to determine if patients have a family cancer syndrome. ↗
▶ Ep 2 · 2:03
quote these polyps have a really high risk of cancer, so it's very important to deal with them. ↗
▶ Ep 2 · 2:03
quote over the last five to ten years, particularly, as we've found out more, it's become clear that these weren't actually hyperplastic, and they were really polyps that are better described as serrated adenomas. ↗
▶ Ep 2 · 3:26
clinical Serrated adenomas are often flat and difficult to see; retroflexion in the cecum is useful because they are often on the inferior or superior side of the valve or on folds. ↗
▶ Ep 2 · 3:26
clinical Serrated adenomas are often flat and difficult to see; retroflexion in the cecum is useful because they are often on the inferior or superior side of the valve or on folds. ↗
▶ Ep 2 · 4:59
quote six centimeters can be a very different thing in many surgeons' minds or gastroenterologists, and it can also be a very different thing depending on the patient. ↗
▶ Ep 2 · 4:59
clinical Six centimeters from the anal verge can be mid-rectum in a small patient (90-pound, 80-year-old female) or close to the dentate line in a large patient (6'6", 300 pounds). ↗
▶ Ep 2 · 4:59
quote six centimeters can be a very different thing in many surgeons' minds or gastroenterologists, and it can also be a very different thing depending on the patient. ↗
▶ Ep 2 · 4:59
guideline Distal margin requirements for rectal resection: 5 centimeters if possible, 2 centimeters if possible, and for very lowest tumors perhaps 1 centimeter as long as they are not poorly differentiated. ↗
▶ Ep 2 · 4:59
clinical Six centimeters from the anal verge can be mid-rectum in a small patient (90-pound, 80-year-old female) or close to the dentate line in a large patient (6'6", 300 pounds). ↗
▶ Ep 2 · 4:59
guideline Distal margin requirements for rectal resection: 5 centimeters if possible, 2 centimeters if possible, and for very lowest tumors perhaps 1 centimeter as long as they are not poorly differentiated. ↗
▶ Ep 2 · 9:03
epidemiological With optimized surgery, imaging, and patient selection, local recurrence rates for rectal cancer should be under 10 percent; Cleveland Clinic's rate over the last 10 years was about 3 percent. ↗
▶ Ep 2 · 9:03
epidemiological Historical local recurrence rates for rectal cancer from good institutions were 20 to 38 percent, with some up to 50 percent. ↗
▶ Ep 2 · 9:03
epidemiological Historical local recurrence rates for rectal cancer from good institutions were 20 to 38 percent, with some up to 50 percent. ↗
▶ Ep 2 · 9:03
epidemiological With optimized surgery, imaging, and patient selection, local recurrence rates for rectal cancer should be under 10 percent; Cleveland Clinic's rate over the last 10 years was about 3 percent. ↗
▶ Ep 2 · 9:03
guideline For total mesorectal excision, the circumferential resection margin should be one to two millimeters; if threatened, this is an indication for neoadjuvant therapy or extended resection. ↗
▶ Ep 2 · 9:03
clinical A total mesorectal excision can be performed with about 5 milliliters of blood loss because it is a bloodless plane; bleeding indicates being outside that plane or in the wrong plane. ↗
▶ Ep 2 · 9:03
guideline Most accepted guidelines for neoadjuvant therapy in rectal cancer are for tumors that are T3 (outside the wall of the rectum) or node positive. ↗
▶ Ep 2 · 9:03
quote If you look back in the literature for rectal cancer, local recurrence rates in series from good institutions were 20 to 38 percent and some up to 50 percent. Nowadays, really, it should be under 10 percent. And if you look at our last 10 years, Jeff, it was about 3 percent. ↗
▶ Ep 2 · 9:03
quote you can take out a whole rectum with about 5 mils of blood loss because it's a bloodless plane. And if you've got bleeding, you hopefully are deliberately outside of that plane, but otherwise you're in the wrong plane. ↗
▶ Ep 2 · 9:03
quote you can take out a whole rectum with about 5 mils of blood loss because it's a bloodless plane. And if you've got bleeding, you hopefully are deliberately outside of that plane, but otherwise you're in the wrong plane. ↗
▶ Ep 2 · 9:03
quote If you look back in the literature for rectal cancer, local recurrence rates in series from good institutions were 20 to 38 percent and some up to 50 percent. Nowadays, really, it should be under 10 percent. And if you look at our last 10 years, Jeff, it was about 3 percent. ↗
▶ Ep 2 · 9:03
guideline Most accepted guidelines for neoadjuvant therapy in rectal cancer are for tumors that are T3 (outside the wall of the rectum) or node positive. ↗
▶ Ep 2 · 9:03
clinical A total mesorectal excision can be performed with about 5 milliliters of blood loss because it is a bloodless plane; bleeding indicates being outside that plane or in the wrong plane. ↗
▶ Ep 2 · 9:03
guideline For total mesorectal excision, the circumferential resection margin should be one to two millimeters; if threatened, this is an indication for neoadjuvant therapy or extended resection. ↗
▶ Ep 2 · 13:11
guideline For node-negative T1 or T2 rectal tumors (stage one), particularly if upper third, neoadjuvant therapy can be omitted. ↗
▶ Ep 2 · 13:11
guideline For node-negative T1 or T2 rectal tumors (stage one), particularly if upper third, neoadjuvant therapy can be omitted. ↗
▶ Ep 2 · 13:18
clinical Endoscopic ultrasound is much more operator dependent and probably only 70% accurate for predicting nodal involvement in rectal cancer. ↗
▶ Ep 2 · 13:18
clinical MRI is probably 90 to mid-90s percent accurate at T staging and high 80s to 90% accurate for nodal staging in rectal cancer. ↗
▶ Ep 2 · 13:18
clinical MRI is probably 90 to mid-90s percent accurate at T staging and high 80s to 90% accurate for nodal staging in rectal cancer. ↗
▶ Ep 2 · 13:18
clinical Endoscopic ultrasound is much more operator dependent and probably only 70% accurate for predicting nodal involvement in rectal cancer. ↗
▶ Ep 2 · 14:07
quote if you look at the historical local recurrence rates for these transanally excised rectal cancers, it was about 18%. And it was remarkably consistent across outcome data from several big centers, about 18%. ↗
▶ Ep 2 · 14:07
guideline Transanal resection is generally appropriate for tumors less than a third of the circumference, ideally less than two centimeters, that are T1. ↗
▶ Ep 2 · 14:07
opinion For young, curable patients, most surgeons favor radical resection over transanal resection; transanal resection is generally kept for patients unfit for rectal resection or those whose tumor is so close to the dentate line that a permanent stoma would be required. ↗
▶ Ep 2 · 14:07
epidemiological Historical local recurrence rates for transanally excised rectal cancers were about 18%, remarkably consistent across outcome data from several big centers. ↗
▶ Ep 2 · 14:07
opinion For young, curable patients, most surgeons favor radical resection over transanal resection; transanal resection is generally kept for patients unfit for rectal resection or those whose tumor is so close to the dentate line that a permanent stoma would be required. ↗
▶ Ep 2 · 14:07
quote if you look at the historical local recurrence rates for these transanally excised rectal cancers, it was about 18%. And it was remarkably consistent across outcome data from several big centers, about 18%. ↗
▶ Ep 2 · 14:07
epidemiological Historical local recurrence rates for transanally excised rectal cancers were about 18%, remarkably consistent across outcome data from several big centers. ↗
▶ Ep 2 · 14:07
guideline Transanal resection is generally appropriate for tumors less than a third of the circumference, ideally less than two centimeters, that are T1. ↗
▶ Ep 2 · 16:23
clinical For rectal cancer, full-thickness excision is required; ESD (endoscopic submucosal dissection) would never be done for a proven cancer, only for benign polyps. ↗
▶ Ep 2 · 16:23
clinical For rectal cancer, full-thickness excision is required; ESD (endoscopic submucosal dissection) would never be done for a proven cancer, only for benign polyps. ↗
▶ Ep 2 · 17:25
quote 25 gray over a short period is equivalent to 40 to 45 over a longer period. But it can make a big difference for tumor response. ↗
▶ Ep 2 · 17:25
guideline In Europe, short-course radiation is five times five gray given over five days, with surgery about one to two weeks later. ↗
▶ Ep 2 · 17:25
guideline In the U.S., long-course radiation is 40 to 45 gray given with chemotherapy over six weeks, followed by a six to eight week waiting period. ↗
▶ Ep 2 · 17:25
clinical Twenty-five gray over a short period is radiotherapeutically equivalent to 40 to 45 gray over a longer period, but longer course can make a big difference for tumor response and physical downstaging. ↗
▶ Ep 2 · 17:25
guideline In Europe, short-course radiation is five times five gray given over five days, with surgery about one to two weeks later. ↗
▶ Ep 2 · 17:25
guideline In the U.S., long-course radiation is 40 to 45 gray given with chemotherapy over six weeks, followed by a six to eight week waiting period. ↗
▶ Ep 2 · 17:25
clinical Twenty-five gray over a short period is radiotherapeutically equivalent to 40 to 45 gray over a longer period, but longer course can make a big difference for tumor response and physical downstaging. ↗
▶ Ep 2 · 17:25
quote 25 gray over a short period is equivalent to 40 to 45 over a longer period. But it can make a big difference for tumor response. ↗
▶ Ep 2 · 19:22
guideline For colon cancer surgery, goals include at least a 5 centimeter proximal and distal margin (usually determined by blood supply) and at least 12 lymph nodes, with many surgeons hoping for at least 16. ↗
▶ Ep 2 · 19:22
guideline For colon cancer surgery, goals include at least a 5 centimeter proximal and distal margin (usually determined by blood supply) and at least 12 lymph nodes, with many surgeons hoping for at least 16. ↗
▶ Ep 2 · 19:22
quote if you look at the Scandinavian data, I mentioned their local recurrence rates were 27%, high 20s, when they were doing some very good rectal cancer trials. They focused on rectal cancer surgical technique and got the local recurrence rate down to under 10%. While their local recurrence rate for colon cancer was even higher than their rectal cancer local recurrence rate, because they realized they weren't doing adequate colon cancer surgery. ↗
▶ Ep 2 · 19:22
clinical Total mesocolic excision should be performed in the plane between the embryological peritoneum of the retroperitoneum (Toldt's fascia) and the embryological peritoneum on the mesocolon, keeping the mesocolon complete. ↗
▶ Ep 2 · 19:22
quote if you look at the Scandinavian data, I mentioned their local recurrence rates were 27%, high 20s, when they were doing some very good rectal cancer trials. They focused on rectal cancer surgical technique and got the local recurrence rate down to under 10%. While their local recurrence rate for colon cancer was even higher than their rectal cancer local recurrence rate, because they realized they weren't doing adequate colon cancer surgery. ↗
▶ Ep 2 · 19:22
clinical Total mesocolic excision should be performed in the plane between the embryological peritoneum of the retroperitoneum (Toldt's fascia) and the embryological peritoneum on the mesocolon, keeping the mesocolon complete. ↗
▶ Ep 2 · 19:22
epidemiological Scandinavian data showed local recurrence rates for colon cancer were even higher than for rectal cancer (which was high 20s percent) because they realized they weren't doing adequate colon cancer surgery. ↗
▶ Ep 2 · 19:22
epidemiological Scandinavian data showed local recurrence rates for colon cancer were even higher than for rectal cancer (which was high 20s percent) because they realized they weren't doing adequate colon cancer surgery. ↗
▶ Ep 2 · 22:44
guideline For a cecal tumor or lesion near the ileocecal valve, 10 centimeters of small bowel should be taken; for mid-ascending colon, 5 centimeters should be taken. ↗
▶ Ep 2 · 22:44
guideline For a cecal tumor or lesion near the ileocecal valve, 10 centimeters of small bowel should be taken; for mid-ascending colon, 5 centimeters should be taken. ↗
▶ Ep 2 · 23:59
epidemiological Extracorporeal stapled anastomosis for right colectomy has reported leak rates of 0.8% over 1,000 cases at Cleveland Clinic. ↗
▶ Ep 2 · 23:59
epidemiological Extracorporeal stapled anastomosis for right colectomy has reported leak rates of 0.8% over 1,000 cases at Cleveland Clinic. ↗
▶ Ep 2 · 24:32
guideline Genetic workup should be considered for patients with cancer under age 40, first-degree relatives with cancer, multiple cancers in a family, or non-GI cancers in a family. ↗
▶ Ep 2 · 24:32
clinical Genetic findings may change the surgical operation: a patient with a right colon cancer plus multiple polyps or significant family history may be better served with a subtotal colectomy rather than segmental resection. ↗
▶ Ep 2 · 24:32
clinical Genetic findings may change the surgical operation: a patient with a right colon cancer plus multiple polyps or significant family history may be better served with a subtotal colectomy rather than segmental resection. ↗
▶ Ep 2 · 24:32
guideline Genetic workup should be considered for patients with cancer under age 40, first-degree relatives with cancer, multiple cancers in a family, or non-GI cancers in a family. ↗

Colorectal Cancer

▶ Ep 3 · 1:15
clinical Colonoscopy is still the best test available for colon cancer detection, finding the vast majority of cancers and polyps, though not perfect. ↗
▶ Ep 3 · 1:15
quote Colonoscopy is still very important. It's still the best test that we have. There is no perfect test, and we know that colonoscopy doesn't find every cancer, although it finds the vast majority, every polyp, although it finds the vast majority. But it's certainly the best thing we have. ↗
▶ Ep 3 · 1:15
quote Colonoscopy is still very important. It's still the best test that we have. There is no perfect test, and we know that colonoscopy doesn't find every cancer, although it finds the vast majority, every polyp, although it finds the vast majority. But it's certainly the best thing we have. ↗
▶ Ep 3 · 1:15
clinical Colonoscopy is still the best test available for colon cancer detection, finding the vast majority of cancers and polyps, though not perfect. ↗
▶ Ep 3 · 2:03
quote these polyps have a really high risk of cancer, so it's very important to deal with them. ↗
▶ Ep 3 · 2:03
clinical Serrated polyps have a very high risk of cancer and require family assessment to determine if patients have a family cancer syndrome. ↗
▶ Ep 3 · 2:03
clinical Serrated adenomas (previously misclassified as hyperplastic polyps) have good evidence of genetic predisposition and tie into many family cancer syndromes. ↗
▶ Ep 3 · 2:03
quote over the last five to ten years, particularly, as we've found out more, it's become clear that these weren't actually hyperplastic, and they were really polyps that are better described as serrated adenomas. ↗
▶ Ep 3 · 2:03
clinical Serrated adenomas (previously misclassified as hyperplastic polyps) have good evidence of genetic predisposition and tie into many family cancer syndromes. ↗
▶ Ep 3 · 2:03
quote over the last five to ten years, particularly, as we've found out more, it's become clear that these weren't actually hyperplastic, and they were really polyps that are better described as serrated adenomas. ↗
▶ Ep 3 · 2:03
clinical Serrated polyps have a very high risk of cancer and require family assessment to determine if patients have a family cancer syndrome. ↗
▶ Ep 3 · 2:03
quote these polyps have a really high risk of cancer, so it's very important to deal with them. ↗
▶ Ep 3 · 3:26
clinical Serrated adenomas are often flat and difficult to see; retroflexion in the cecum is useful because they are often on the inferior or superior side of the valve or on folds. ↗
▶ Ep 3 · 3:26
clinical Serrated adenomas are often flat and difficult to see; retroflexion in the cecum is useful because they are often on the inferior or superior side of the valve or on folds. ↗
▶ Ep 3 · 4:59
guideline Distal margin requirements for rectal resection: 5 centimeters if possible, 2 centimeters if possible, and for very lowest tumors perhaps 1 centimeter as long as they are not poorly differentiated. ↗
▶ Ep 3 · 4:59
guideline Distal margin requirements for rectal resection: 5 centimeters if possible, 2 centimeters if possible, and for very lowest tumors perhaps 1 centimeter as long as they are not poorly differentiated. ↗
▶ Ep 3 · 4:59
quote six centimeters can be a very different thing in many surgeons' minds or gastroenterologists, and it can also be a very different thing depending on the patient. ↗
▶ Ep 3 · 4:59
quote six centimeters can be a very different thing in many surgeons' minds or gastroenterologists, and it can also be a very different thing depending on the patient. ↗
▶ Ep 3 · 4:59
clinical Six centimeters from the anal verge can be mid-rectum in a small patient (90-pound, 80-year-old female) or close to the dentate line in a large patient (6'6", 300 pounds). ↗
▶ Ep 3 · 4:59
clinical Six centimeters from the anal verge can be mid-rectum in a small patient (90-pound, 80-year-old female) or close to the dentate line in a large patient (6'6", 300 pounds). ↗
▶ Ep 3 · 9:03
epidemiological With optimized surgery, imaging, and patient selection, local recurrence rates for rectal cancer should be under 10 percent; Cleveland Clinic's rate over the last 10 years was about 3 percent. ↗
▶ Ep 3 · 9:03
guideline For total mesorectal excision, the circumferential resection margin should be one to two millimeters; if threatened, this is an indication for neoadjuvant therapy or extended resection. ↗
▶ Ep 3 · 9:03
clinical A total mesorectal excision can be performed with about 5 milliliters of blood loss because it is a bloodless plane; bleeding indicates being outside that plane or in the wrong plane. ↗
▶ Ep 3 · 9:03
guideline Most accepted guidelines for neoadjuvant therapy in rectal cancer are for tumors that are T3 (outside the wall of the rectum) or node positive. ↗
▶ Ep 3 · 9:03
quote If you look back in the literature for rectal cancer, local recurrence rates in series from good institutions were 20 to 38 percent and some up to 50 percent. Nowadays, really, it should be under 10 percent. And if you look at our last 10 years, Jeff, it was about 3 percent. ↗
▶ Ep 3 · 9:03
quote you can take out a whole rectum with about 5 mils of blood loss because it's a bloodless plane. And if you've got bleeding, you hopefully are deliberately outside of that plane, but otherwise you're in the wrong plane. ↗
▶ Ep 3 · 9:03
epidemiological Historical local recurrence rates for rectal cancer from good institutions were 20 to 38 percent, with some up to 50 percent. ↗
▶ Ep 3 · 9:03
epidemiological With optimized surgery, imaging, and patient selection, local recurrence rates for rectal cancer should be under 10 percent; Cleveland Clinic's rate over the last 10 years was about 3 percent. ↗
▶ Ep 3 · 9:03
guideline For total mesorectal excision, the circumferential resection margin should be one to two millimeters; if threatened, this is an indication for neoadjuvant therapy or extended resection. ↗
▶ Ep 3 · 9:03
clinical A total mesorectal excision can be performed with about 5 milliliters of blood loss because it is a bloodless plane; bleeding indicates being outside that plane or in the wrong plane. ↗
▶ Ep 3 · 9:03
guideline Most accepted guidelines for neoadjuvant therapy in rectal cancer are for tumors that are T3 (outside the wall of the rectum) or node positive. ↗
▶ Ep 3 · 9:03
quote If you look back in the literature for rectal cancer, local recurrence rates in series from good institutions were 20 to 38 percent and some up to 50 percent. Nowadays, really, it should be under 10 percent. And if you look at our last 10 years, Jeff, it was about 3 percent. ↗
▶ Ep 3 · 9:03
quote you can take out a whole rectum with about 5 mils of blood loss because it's a bloodless plane. And if you've got bleeding, you hopefully are deliberately outside of that plane, but otherwise you're in the wrong plane. ↗
▶ Ep 3 · 9:03
epidemiological Historical local recurrence rates for rectal cancer from good institutions were 20 to 38 percent, with some up to 50 percent. ↗
▶ Ep 3 · 13:11
guideline For node-negative T1 or T2 rectal tumors (stage one), particularly if upper third, neoadjuvant therapy can be omitted. ↗
▶ Ep 3 · 13:11
guideline For node-negative T1 or T2 rectal tumors (stage one), particularly if upper third, neoadjuvant therapy can be omitted. ↗
▶ Ep 3 · 13:18
clinical MRI is probably 90 to mid-90s percent accurate at T staging and high 80s to 90% accurate for nodal staging in rectal cancer. ↗
▶ Ep 3 · 13:18
clinical Endoscopic ultrasound is much more operator dependent and probably only 70% accurate for predicting nodal involvement in rectal cancer. ↗
▶ Ep 3 · 13:18
clinical MRI is probably 90 to mid-90s percent accurate at T staging and high 80s to 90% accurate for nodal staging in rectal cancer. ↗
▶ Ep 3 · 13:18
clinical Endoscopic ultrasound is much more operator dependent and probably only 70% accurate for predicting nodal involvement in rectal cancer. ↗
▶ Ep 3 · 14:07
opinion For young, curable patients, most surgeons favor radical resection over transanal resection; transanal resection is generally kept for patients unfit for rectal resection or those whose tumor is so close to the dentate line that a permanent stoma would be required. ↗
▶ Ep 3 · 14:07
guideline Transanal resection is generally appropriate for tumors less than a third of the circumference, ideally less than two centimeters, that are T1. ↗
▶ Ep 3 · 14:07
epidemiological Historical local recurrence rates for transanally excised rectal cancers were about 18%, remarkably consistent across outcome data from several big centers. ↗
▶ Ep 3 · 14:07
opinion For young, curable patients, most surgeons favor radical resection over transanal resection; transanal resection is generally kept for patients unfit for rectal resection or those whose tumor is so close to the dentate line that a permanent stoma would be required. ↗
▶ Ep 3 · 14:07
guideline Transanal resection is generally appropriate for tumors less than a third of the circumference, ideally less than two centimeters, that are T1. ↗
▶ Ep 3 · 14:07
epidemiological Historical local recurrence rates for transanally excised rectal cancers were about 18%, remarkably consistent across outcome data from several big centers. ↗
▶ Ep 3 · 14:07
quote if you look at the historical local recurrence rates for these transanally excised rectal cancers, it was about 18%. And it was remarkably consistent across outcome data from several big centers, about 18%. ↗
▶ Ep 3 · 14:07
quote if you look at the historical local recurrence rates for these transanally excised rectal cancers, it was about 18%. And it was remarkably consistent across outcome data from several big centers, about 18%. ↗
▶ Ep 3 · 16:23
clinical For rectal cancer, full-thickness excision is required; ESD (endoscopic submucosal dissection) would never be done for a proven cancer, only for benign polyps. ↗
▶ Ep 3 · 16:23
clinical For rectal cancer, full-thickness excision is required; ESD (endoscopic submucosal dissection) would never be done for a proven cancer, only for benign polyps. ↗
▶ Ep 3 · 17:25
clinical Twenty-five gray over a short period is radiotherapeutically equivalent to 40 to 45 gray over a longer period, but longer course can make a big difference for tumor response and physical downstaging. ↗
▶ Ep 3 · 17:25
guideline In the U.S., long-course radiation is 40 to 45 gray given with chemotherapy over six weeks, followed by a six to eight week waiting period. ↗
▶ Ep 3 · 17:25
guideline In Europe, short-course radiation is five times five gray given over five days, with surgery about one to two weeks later. ↗
▶ Ep 3 · 17:25
quote 25 gray over a short period is equivalent to 40 to 45 over a longer period. But it can make a big difference for tumor response. ↗
▶ Ep 3 · 17:25
guideline In Europe, short-course radiation is five times five gray given over five days, with surgery about one to two weeks later. ↗
▶ Ep 3 · 17:25
guideline In the U.S., long-course radiation is 40 to 45 gray given with chemotherapy over six weeks, followed by a six to eight week waiting period. ↗
▶ Ep 3 · 17:25
quote 25 gray over a short period is equivalent to 40 to 45 over a longer period. But it can make a big difference for tumor response. ↗
▶ Ep 3 · 17:25
clinical Twenty-five gray over a short period is radiotherapeutically equivalent to 40 to 45 gray over a longer period, but longer course can make a big difference for tumor response and physical downstaging. ↗
▶ Ep 3 · 19:22
clinical Total mesocolic excision should be performed in the plane between the embryological peritoneum of the retroperitoneum (Toldt's fascia) and the embryological peritoneum on the mesocolon, keeping the mesocolon complete. ↗
▶ Ep 3 · 19:22
guideline For colon cancer surgery, goals include at least a 5 centimeter proximal and distal margin (usually determined by blood supply) and at least 12 lymph nodes, with many surgeons hoping for at least 16. ↗
▶ Ep 3 · 19:22
guideline For colon cancer surgery, goals include at least a 5 centimeter proximal and distal margin (usually determined by blood supply) and at least 12 lymph nodes, with many surgeons hoping for at least 16. ↗
▶ Ep 3 · 19:22
quote if you look at the Scandinavian data, I mentioned their local recurrence rates were 27%, high 20s, when they were doing some very good rectal cancer trials. They focused on rectal cancer surgical technique and got the local recurrence rate down to under 10%. While their local recurrence rate for colon cancer was even higher than their rectal cancer local recurrence rate, because they realized they weren't doing adequate colon cancer surgery. ↗
▶ Ep 3 · 19:22
clinical Total mesocolic excision should be performed in the plane between the embryological peritoneum of the retroperitoneum (Toldt's fascia) and the embryological peritoneum on the mesocolon, keeping the mesocolon complete. ↗
▶ Ep 3 · 19:22
quote if you look at the Scandinavian data, I mentioned their local recurrence rates were 27%, high 20s, when they were doing some very good rectal cancer trials. They focused on rectal cancer surgical technique and got the local recurrence rate down to under 10%. While their local recurrence rate for colon cancer was even higher than their rectal cancer local recurrence rate, because they realized they weren't doing adequate colon cancer surgery. ↗
▶ Ep 3 · 19:22
epidemiological Scandinavian data showed local recurrence rates for colon cancer were even higher than for rectal cancer (which was high 20s percent) because they realized they weren't doing adequate colon cancer surgery. ↗
▶ Ep 3 · 19:22
epidemiological Scandinavian data showed local recurrence rates for colon cancer were even higher than for rectal cancer (which was high 20s percent) because they realized they weren't doing adequate colon cancer surgery. ↗
▶ Ep 3 · 22:44
guideline For a cecal tumor or lesion near the ileocecal valve, 10 centimeters of small bowel should be taken; for mid-ascending colon, 5 centimeters should be taken. ↗
▶ Ep 3 · 22:44
guideline For a cecal tumor or lesion near the ileocecal valve, 10 centimeters of small bowel should be taken; for mid-ascending colon, 5 centimeters should be taken. ↗
▶ Ep 3 · 23:59
epidemiological Extracorporeal stapled anastomosis for right colectomy has reported leak rates of 0.8% over 1,000 cases at Cleveland Clinic. ↗
▶ Ep 3 · 23:59
epidemiological Extracorporeal stapled anastomosis for right colectomy has reported leak rates of 0.8% over 1,000 cases at Cleveland Clinic. ↗
▶ Ep 3 · 24:32
guideline Genetic workup should be considered for patients with cancer under age 40, first-degree relatives with cancer, multiple cancers in a family, or non-GI cancers in a family. ↗
▶ Ep 3 · 24:32
guideline Genetic workup should be considered for patients with cancer under age 40, first-degree relatives with cancer, multiple cancers in a family, or non-GI cancers in a family. ↗
▶ Ep 3 · 24:32
clinical Genetic findings may change the surgical operation: a patient with a right colon cancer plus multiple polyps or significant family history may be better served with a subtotal colectomy rather than segmental resection. ↗
▶ Ep 3 · 24:32
clinical Genetic findings may change the surgical operation: a patient with a right colon cancer plus multiple polyps or significant family history may be better served with a subtotal colectomy rather than segmental resection. ↗

Colorectal Cancer

▶ Ep 4 · 1:15
quote Colonoscopy is still very important. It's still the best test that we have. There is no perfect test, and we know that colonoscopy doesn't find every cancer, although it finds the vast majority, every polyp, although it finds the vast majority. ↗
▶ Ep 4 · 1:15
clinical Colonoscopy is still the best test for colon cancer detection, with approximately 90-95% accuracy for finding cancers and polyps, though not perfect. ↗
▶ Ep 4 · 1:15
quote Colonoscopy is still very important. It's still the best test that we have. There is no perfect test, and we know that colonoscopy doesn't find every cancer, although it finds the vast majority, every polyp, although it finds the vast majority. ↗
▶ Ep 4 · 1:15
clinical Colonoscopy is still the best test for colon cancer detection, with approximately 90-95% accuracy for finding cancers and polyps, though not perfect. ↗
▶ Ep 4 · 2:03
quote these polyps have a really high risk of cancer, so it's very important to deal with them. ↗
▶ Ep 4 · 2:03
clinical Serrated adenomas (previously misclassified as hyperplastic polyps) have a very high risk of cancer and are associated with genetic predisposition and family cancer syndromes. ↗
▶ Ep 4 · 2:03
quote over the last five to ten years, particularly, as we've found out more, it's become clear that these weren't actually hyperplastic, and they were really polyps that are better described as serrated adenomas. ↗
▶ Ep 4 · 2:03
guideline Serrated adenomas require family assessment, may necessitate altered colonoscopy frequency, and family members may need colonoscopy or other testing. ↗
▶ Ep 4 · 2:03
quote these polyps have a really high risk of cancer, so it's very important to deal with them. ↗
▶ Ep 4 · 2:03
quote over the last five to ten years, particularly, as we've found out more, it's become clear that these weren't actually hyperplastic, and they were really polyps that are better described as serrated adenomas. ↗
▶ Ep 4 · 2:03
clinical Serrated adenomas (previously misclassified as hyperplastic polyps) have a very high risk of cancer and are associated with genetic predisposition and family cancer syndromes. ↗
▶ Ep 4 · 2:03
guideline Serrated adenomas require family assessment, may necessitate altered colonoscopy frequency, and family members may need colonoscopy or other testing. ↗
▶ Ep 4 · 3:26
clinical Serrated polyps are often flat and difficult to see; retroflexion in the cecum is useful because they are often on the inferior or superior side of the valve or on folds. ↗
▶ Ep 4 · 3:26
clinical Serrated polyps are often flat and difficult to see; retroflexion in the cecum is useful because they are often on the inferior or superior side of the valve or on folds. ↗
▶ Ep 4 · 4:59
quote 6 centimeters in a 90-pound, 80-year-old female can be almost mid-rectum. 6 centimeters in a guy who's 6'6 and 300 pounds can be the top of the anal canal or even close to the dentate line. ↗
▶ Ep 4 · 4:59
guideline For rectal cancer, distal margin requirements are 5 cm if achievable, 2 cm if achievable, and for very low tumors 1 cm is acceptable as long as they are not poorly differentiated. ↗
▶ Ep 4 · 4:59
clinical Six centimeters from the anal verge can mean different things depending on patient size: in a small elderly female it may be mid-rectum, while in a large male it can be near the dentate line. ↗
▶ Ep 4 · 4:59
quote 6 centimeters in a 90-pound, 80-year-old female can be almost mid-rectum. 6 centimeters in a guy who's 6'6 and 300 pounds can be the top of the anal canal or even close to the dentate line. ↗
▶ Ep 4 · 4:59
quote your distal margin needs to be 5 centimeters if you can get it, 2 centimeters if you can get it, and for the very lowest tumors, perhaps 1 centimeter as long as they're not poorly differentiated. ↗
▶ Ep 4 · 4:59
quote your distal margin needs to be 5 centimeters if you can get it, 2 centimeters if you can get it, and for the very lowest tumors, perhaps 1 centimeter as long as they're not poorly differentiated. ↗
▶ Ep 4 · 4:59
clinical Six centimeters from the anal verge can mean different things depending on patient size: in a small elderly female it may be mid-rectum, while in a large male it can be near the dentate line. ↗
▶ Ep 4 · 4:59
guideline For rectal cancer, distal margin requirements are 5 cm if achievable, 2 cm if achievable, and for very low tumors 1 cm is acceptable as long as they are not poorly differentiated. ↗
▶ Ep 4 · 6:51
clinical Upper third rectal cancers likely do not need preoperative therapy or stoma, while middle and lower third cancers have a good chance of needing neoadjuvant therapy and temporary or rarely permanent stoma. ↗
▶ Ep 4 · 6:51
clinical Upper third rectal cancers likely do not need preoperative therapy or stoma, while middle and lower third cancers have a good chance of needing neoadjuvant therapy and temporary or rarely permanent stoma. ↗
▶ Ep 4 · 9:03
guideline Distant staging for rectal cancer is best done with CT abdomen for liver assessment and CT chest (now preferred over chest x-ray per most guidelines). ↗
▶ Ep 4 · 9:03
guideline Distant staging for rectal cancer is best done with CT abdomen for liver assessment and CT chest (now preferred over chest x-ray per most guidelines). ↗
▶ Ep 4 · 9:03
guideline MRI with high-resolution, high Tesla magnet and standardized protocol (developed by Bill Heald and Gina Brown at Royal Marsden) is now the standard for local staging of rectal cancer. ↗
▶ Ep 4 · 9:03
guideline MRI with high-resolution, high Tesla magnet and standardized protocol (developed by Bill Heald and Gina Brown at Royal Marsden) is now the standard for local staging of rectal cancer. ↗
▶ Ep 4 · 10:43
epidemiological Historical local recurrence rates for rectal cancer from good institutions were 20-38%, with some up to 50%, but with optimized surgery and imaging should now be under 10%. ↗
▶ Ep 4 · 10:43
clinical MRI is approximately 90-95% accurate for T staging and high 80s to 90% accurate for nodal staging in rectal cancer. ↗
▶ Ep 4 · 10:43
epidemiological Historical local recurrence rates for rectal cancer from good institutions were 20-38%, with some up to 50%, but with optimized surgery and imaging should now be under 10%. ↗
▶ Ep 4 · 10:43
epidemiological Cleveland Clinic's local recurrence rate for rectal cancer over the last 10 years was approximately 3%. ↗
▶ Ep 4 · 10:43
clinical Circumferential resection margin is the most important margin in rectal cancer surgery; a negative pathological margin results in low chance of local recurrence. ↗
▶ Ep 4 · 10:43
clinical Total mesorectal excision (TME) can be performed with about 5 mL of blood loss because it is a bloodless plane; bleeding indicates being outside that plane or deliberately in the wrong plane. ↗
▶ Ep 4 · 10:43
quote if you look back in the literature for rectal cancer, local recurrence rates in series from good institutions were 20 to 38 percent and some up to 50 percent. Nowadays, really, it should be under 10 percent. And if you look at our last 10 years, Jeff, it was about 3 percent. ↗
▶ Ep 4 · 10:43
quote when you do an operation on these patients, you've got to do it in a way that they have a negative pathological margin. If you have a negative pathological margin, the chance of local recurrence is low. ↗
▶ Ep 4 · 10:43
quote you can take out a whole rectum with about 5 mils of blood loss because it's a bloodless plane. And if you've got bleeding, you hopefully are deliberately outside of that plane, but otherwise you're in the wrong plane. ↗
▶ Ep 4 · 10:43
quote if you look back in the literature for rectal cancer, local recurrence rates in series from good institutions were 20 to 38 percent and some up to 50 percent. Nowadays, really, it should be under 10 percent. And if you look at our last 10 years, Jeff, it was about 3 percent. ↗
▶ Ep 4 · 10:43
clinical MRI is approximately 90-95% accurate for T staging and high 80s to 90% accurate for nodal staging in rectal cancer. ↗
▶ Ep 4 · 10:43
epidemiological Cleveland Clinic's local recurrence rate for rectal cancer over the last 10 years was approximately 3%. ↗
▶ Ep 4 · 10:43
clinical Circumferential resection margin is the most important margin in rectal cancer surgery; a negative pathological margin results in low chance of local recurrence. ↗
▶ Ep 4 · 10:43
clinical Total mesorectal excision (TME) can be performed with about 5 mL of blood loss because it is a bloodless plane; bleeding indicates being outside that plane or deliberately in the wrong plane. ↗
▶ Ep 4 · 10:43
quote when you do an operation on these patients, you've got to do it in a way that they have a negative pathological margin. If you have a negative pathological margin, the chance of local recurrence is low. ↗
▶ Ep 4 · 10:43
quote you can take out a whole rectum with about 5 mils of blood loss because it's a bloodless plane. And if you've got bleeding, you hopefully are deliberately outside of that plane, but otherwise you're in the wrong plane. ↗
▶ Ep 4 · 13:11
guideline Stage I rectal cancer (node negative and T1 or T2), particularly if upper third, does not require preoperative radiation. ↗
▶ Ep 4 · 13:11
quote MRI is probably 90 to mid 90s accurate at T staging, and it's probably high 80s to 90% accurate for nodal staging. ↗
▶ Ep 4 · 13:11
clinical Endoscopic ultrasound is only about 70% accurate for predicting nodal involvement in rectal cancer and is much more operator dependent than MRI. ↗
▶ Ep 4 · 13:11
guideline Stage I rectal cancer (node negative and T1 or T2), particularly if upper third, does not require preoperative radiation. ↗
▶ Ep 4 · 13:11
guideline Neoadjuvant therapy is indicated for rectal tumors that are T3 (outside the wall) or node positive. ↗
▶ Ep 4 · 13:11
clinical Endoscopic ultrasound is only about 70% accurate for predicting nodal involvement in rectal cancer and is much more operator dependent than MRI. ↗
▶ Ep 4 · 13:11
quote Ultrasound is much more operator dependent, and it's probably only 70% accurate for predicting nodal involvement. ↗
▶ Ep 4 · 13:11
quote Ultrasound is much more operator dependent, and it's probably only 70% accurate for predicting nodal involvement. ↗
▶ Ep 4 · 13:11
guideline Neoadjuvant therapy is indicated for rectal tumors that are T3 (outside the wall) or node positive. ↗
▶ Ep 4 · 13:11
quote MRI is probably 90 to mid 90s accurate at T staging, and it's probably high 80s to 90% accurate for nodal staging. ↗
▶ Ep 4 · 14:07
opinion For young, curable patients, radical resection is generally favored over transanal resection; transanal approaches are reserved for patients unfit for rectal resection or those whose tumor location would require permanent stoma. ↗
▶ Ep 4 · 14:07
epidemiological Historical local recurrence rates for transanally excised rectal cancers were approximately 18%, remarkably consistent across several major centers. ↗
▶ Ep 4 · 14:07
guideline Transanal resection is appropriate for tumors less than one-third circumference, ideally less than 2 cm, that are T1. ↗
▶ Ep 4 · 14:07
quote if you look at the historical local recurrence rates for these transanally excised rectal cancers, it was about 18%. And it was remarkably consistent across outcome data from several big centers, about 18%. ↗
▶ Ep 4 · 14:07
quote if you look at the historical local recurrence rates for these transanally excised rectal cancers, it was about 18%. And it was remarkably consistent across outcome data from several big centers, about 18%. ↗
▶ Ep 4 · 14:07
opinion For young, curable patients, radical resection is generally favored over transanal resection; transanal approaches are reserved for patients unfit for rectal resection or those whose tumor location would require permanent stoma. ↗
▶ Ep 4 · 14:07
epidemiological Historical local recurrence rates for transanally excised rectal cancers were approximately 18%, remarkably consistent across several major centers. ↗
▶ Ep 4 · 14:07
guideline Transanal resection is appropriate for tumors less than one-third circumference, ideally less than 2 cm, that are T1. ↗
▶ Ep 4 · 15:58
guideline Rectal cancer requires full-thickness excision; endoscopic submucosal dissection (ESD) would never be used for proven or high-risk cancer, only for benign polyps. ↗
▶ Ep 4 · 15:58
guideline Rectal cancer requires full-thickness excision; endoscopic submucosal dissection (ESD) would never be used for proven or high-risk cancer, only for benign polyps. ↗
▶ Ep 4 · 16:23
quote if it's a rectal cancer, it needs to be a full thickness excision. So you would never do an ESD type procedure. ↗
▶ Ep 4 · 16:23
quote if it's a rectal cancer, it needs to be a full thickness excision. So you would never do an ESD type procedure. ↗
▶ Ep 4 · 17:25
guideline Short-course radiation (5×5 Gy over 5 days, surgery 1-2 weeks later) is preferred in Europe, while long-course chemoradiation (40-45 Gy over 6 weeks with 6-8 week wait) is preferred in the U.S. ↗
▶ Ep 4 · 17:25
clinical 25 Gy over a short period is radiotherapeutically equivalent to 40-45 Gy over a longer period, but long-course therapy produces greater tumor downstaging and is preferred for bulky tumors. ↗
▶ Ep 4 · 17:25
quote In Europe, it's very much gone towards five times five gray, given over five days. And then you operate about a week to two weeks later. In Europe, sorry, in the U.S., for a variety of reasons, it's a six-week, 40 to 45 gray, given with chemotherapy, staged over six weeks, and then a six-week to eight-week waiting period. ↗
▶ Ep 4 · 17:25
guideline Short-course radiation (5×5 Gy over 5 days, surgery 1-2 weeks later) is preferred in Europe, while long-course chemoradiation (40-45 Gy over 6 weeks with 6-8 week wait) is preferred in the U.S. ↗
▶ Ep 4 · 17:25
clinical 25 Gy over a short period is radiotherapeutically equivalent to 40-45 Gy over a longer period, but long-course therapy produces greater tumor downstaging and is preferred for bulky tumors. ↗
▶ Ep 4 · 17:25
quote In Europe, it's very much gone towards five times five gray, given over five days. And then you operate about a week to two weeks later. In Europe, sorry, in the U.S., for a variety of reasons, it's a six-week, 40 to 45 gray, given with chemotherapy, staged over six weeks, and then a six-week to eight-week waiting period. ↗
▶ Ep 4 · 19:22
guideline For colon cancer, surgeons should aim for at least 12 lymph nodes, though many hope for at least 16. ↗
▶ Ep 4 · 19:22
clinical High ligation of the inferior mesenteric artery (above the takeoff of the left colic artery) is performed in sigmoid colectomy, with protection of autonomic nerves to preserve sexual function. ↗
▶ Ep 4 · 19:22
clinical Total mesocolic excision should be performed in the plane between Toltz fascia (retroperitoneal embryological peritoneum) and the mesocolon peritoneum, achieving complete mesocolic specimen with minimal blood loss. ↗
▶ Ep 4 · 19:22
clinical High ligation of the inferior mesenteric artery (above the takeoff of the left colic artery) is performed in sigmoid colectomy, with protection of autonomic nerves to preserve sexual function. ↗
▶ Ep 4 · 19:22
guideline For colon cancer, surgeons should aim for at least 12 lymph nodes, though many hope for at least 16. ↗
▶ Ep 4 · 19:22
epidemiological Scandinavian data showed local recurrence rates for colon cancer were higher than for rectal cancer (despite rectal rates of high 20s) because adequate colon cancer surgery technique was not being performed. ↗
▶ Ep 4 · 19:22
clinical Total mesocolic excision should be performed in the plane between Toltz fascia (retroperitoneal embryological peritoneum) and the mesocolon peritoneum, achieving complete mesocolic specimen with minimal blood loss. ↗
▶ Ep 4 · 19:22
epidemiological Scandinavian data showed local recurrence rates for colon cancer were higher than for rectal cancer (despite rectal rates of high 20s) because adequate colon cancer surgery technique was not being performed. ↗
▶ Ep 4 · 21:23
clinical For mid-sigmoid cancer (35-40 cm), resection can extend from mid-descending colon to rectosigmoid junction without necessarily taking the splenic flexure, provided there is good vascularity with pulsatile flow. ↗
▶ Ep 4 · 21:23
clinical For mid-sigmoid cancer (35-40 cm), resection can extend from mid-descending colon to rectosigmoid junction without necessarily taking the splenic flexure, provided there is good vascularity with pulsatile flow. ↗
▶ Ep 4 · 22:44
guideline For cecal tumors, 10 cm of small bowel should be taken; for mid-ascending colon tumors, 5 cm of small bowel is adequate. ↗
▶ Ep 4 · 22:44
guideline For cecal tumors, 10 cm of small bowel should be taken; for mid-ascending colon tumors, 5 cm of small bowel is adequate. ↗
▶ Ep 4 · 23:55
epidemiological Extracorporeal stapled anastomosis through the extraction site for laparoscopic right colectomy has achieved leak rates of 0.8% over 1,000 cases at Cleveland Clinic. ↗
▶ Ep 4 · 23:55
epidemiological Extracorporeal stapled anastomosis through the extraction site for laparoscopic right colectomy has achieved leak rates of 0.8% over 1,000 cases at Cleveland Clinic. ↗
▶ Ep 4 · 24:32
clinical Cleveland Clinic has a low threshold for genetic assessment, consulting coordinators when patients meet Bethesda criteria, have first-degree relatives with cancer, young family members with cancer, or multiple cancers in the family. ↗
▶ Ep 4 · 24:32
clinical Cleveland Clinic has a low threshold for genetic assessment, consulting coordinators when patients meet Bethesda criteria, have first-degree relatives with cancer, young family members with cancer, or multiple cancers in the family. ↗
▶ Ep 4 · 24:32
clinical Genetic diagnosis may change the surgical approach: patients with multiple polyps or significant family history may be better served with subtotal colectomy (ileosigmoid or ileorectal anastomosis) rather than segmental resection. ↗
▶ Ep 4 · 24:32
clinical Genetic diagnosis may change the surgical approach: patients with multiple polyps or significant family history may be better served with subtotal colectomy (ileosigmoid or ileorectal anastomosis) rather than segmental resection. ↗
Conor's statements about Soft Tissue Sarcoma (lymph nodes) 38 statements

Open the Soft Tissue Sarcoma (lymph nodes) collection →

Colon Cancer with Conor Delaney

▶ Ep 7 · 1:16
quote colonoscopy is still very important. It's still the best test that we have. There is no perfect test, and we know that colonoscopy doesn't find every cancer, although it finds the vast majority, every polyp, although it finds the vast majority, but it's certainly the best thing we have ↗
▶ Ep 7 · 1:16
clinical Colonoscopy is still the best test for colon cancer detection, finding the vast majority of cancers and polyps, though not perfect. ↗
▶ Ep 7 · 2:05
clinical Serrated adenomas (previously misclassified as hyperplastic polyps, particularly large ones in the right colon) have genetic predisposition, tie into family cancer syndromes, and carry very high cancer risk. ↗
▶ Ep 7 · 2:38
quote these polyps have a really high risk of cancer. So it's very important to deal with them, but third is that it's very important to be able to tell the patient that they're at higher risk ↗
▶ Ep 7 · 2:42
guideline Finding serrated adenomas requires family assessment for hereditary cancer syndromes and may necessitate changes in colonoscopy frequency and family member screening. ↗
▶ Ep 7 · 3:27
clinical Serrated polyps can be flat and difficult to visualize; retroflexion in the cecum is increasingly used because they are often on the inferior or superior side of folds. ↗
▶ Ep 7 · 6:13
clinical For rectal cancer, distal margin requirements are 5 cm if achievable, 2 cm if necessary, and 1 cm for very low tumors as long as they are not poorly differentiated. ↗
▶ Ep 7 · 7:25
clinical The measurement '6 centimeters from the anal verge' varies significantly by patient body habitus and can represent different anatomical locations (anorectal ring vs. near dentate line). ↗
▶ Ep 7 · 8:01
quote 6 centimeters doesn't mean 6 centimeters. It's not the same to everybody and it's not the same to every patient. ↗
▶ Ep 7 · 9:31
guideline Distant staging for rectal cancer is best performed with CT abdomen (for liver metastases) and CT chest (replacing chest X-ray per current guidelines). ↗
▶ Ep 7 · 9:50
clinical MRI has become the standard for local staging of rectal cancer, with high-resolution, high-Tesla magnets using standardized protocols developed by Bill Heald and Gina Brown at the Royal Marsden. ↗
▶ Ep 7 · 10:27
clinical MRI is particularly good at distinguishing T3 and T4 tumors and assessing circumferential resection margins, though less accurate at distinguishing T1 from T2. ↗
▶ Ep 7 · 10:39
clinical Circumferential resection margin is the most important margin (or many think more important than distal margin) for preventing local recurrence in rectal cancer. ↗
▶ Ep 7 · 10:51
quote if you look back in the literature for rectal cancer. Local recurrence rates in series from good institutions were 20 to 38% and some up to 50%. Nowadays, really it should be under 10%, and if you look at our last 10 years, Jeff, it was about 3%. ↗
▶ Ep 7 · 10:51
epidemiological Historical local recurrence rates for rectal cancer from good institutions were 20–38%, with some series up to 50%. ↗
▶ Ep 7 · 11:04
epidemiological With optimized surgery and imaging, local recurrence rates for rectal cancer should now be under 10%; Cleveland Clinic's rate over the last 10 years was about 3%. ↗
▶ Ep 7 · 11:57
quote when you do an operation, and we'll come back to the neoadjuvant treatment, but when you do the operation on these patients, you've got to do it in a way that they have a negative pathological margin. If you have a negative pathological margin, the chance of local recurrence is low. ↗
▶ Ep 7 · 12:24
clinical Total mesorectal excision (TME) can be performed with about 5 mL of blood loss because it follows a bloodless embryological plane; bleeding indicates wrong plane unless deliberately outside TME plane. ↗
▶ Ep 7 · 12:24
quote you can take out a whole rectum with about 5 mL of blood loss because it's a bloodless plane. And if you've got bleeding, you hopefully are deliberately outside of that plane, but otherwise you're in the wrong plane. ↗
▶ Ep 7 · 12:54
guideline Neoadjuvant therapy for rectal cancer is indicated for T3 tumors (outside the rectal wall) or node-positive disease. ↗
▶ Ep 7 · 13:18
guideline Stage 1 rectal cancer (node-negative, T1 or T2), particularly in the upper third of the rectum, does not require neoadjuvant therapy. ↗
▶ Ep 7 · 13:37
clinical MRI is 90 to mid-90s percent accurate for T-staging and high 80s to 90% accurate for nodal staging of rectal cancer. ↗
▶ Ep 7 · 13:56
clinical Endoscopic ultrasound is only about 70% accurate for predicting nodal involvement in rectal cancer and is much more operator-dependent than MRI. ↗
▶ Ep 7 · 14:35
guideline Transanal resection for rectal cancer is generally limited to T1 tumors less than one-third circumference and ideally less than 2 cm. ↗
▶ Ep 7 · 14:51
epidemiological Historical local recurrence rates for transanally excised rectal cancers were about 18%, remarkably consistent across multiple centers. ↗
▶ Ep 7 · 15:05
opinion Transanal endoscopic microsurgery (TEM) may produce better outcomes than traditional transanal excision, though it is unclear whether this is due to technology or improved surgical understanding. ↗
▶ Ep 7 · 15:27
guideline For young, curable patients, radical resection is generally favored over transanal resection; transanal resection is typically reserved for patients unfit for radical surgery or those who would require permanent stoma. ↗
▶ Ep 7 · 16:24
clinical For rectal cancer, full-thickness excision is required; ESD or EMR is never appropriate for proven cancer, only for benign polyps. ↗
▶ Ep 7 · 18:04
guideline Short-course radiation (5×5 Gy over 5 days, surgery 1–2 weeks later) is commonly used in Europe; long-course chemoradiation (40–45 Gy over 6 weeks with 6–8 week wait) is standard in the US. ↗
▶ Ep 7 · 18:26
clinical 25 Gy over a short period is radiotherapeutically equivalent to 40–45 Gy over a longer period, but long-course therapy may produce better tumor downstaging for bulky tumors. ↗
▶ Ep 7 · 19:51
guideline For colon cancer, at least 12 lymph nodes are required for adequate staging, though many surgeons aim for at least 16. ↗
▶ Ep 7 · 19:59
clinical High ligation of the inferior mesenteric artery (above the takeoff of the left colic artery) is standard for sigmoid colectomy, with protection of autonomic nerves to preserve sexual function. ↗
▶ Ep 7 · 20:18
clinical Total mesocolic excision for colon cancer should be performed with about 5 mL of blood loss in the embryological plane between retroperitoneal peritoneum (Toldt's fascia) and mesocolic peritoneum. ↗
▶ Ep 7 · 20:48
epidemiological Scandinavian data showed local recurrence rates for colon cancer were even higher than for rectal cancer (high 20s%) before focus on complete mesocolic excision technique. ↗
▶ Ep 7 · 23:12
clinical For cecal or ileocecal valve tumors, 10 cm of small bowel should be resected; for mid-ascending colon tumors, 5 cm of small bowel is adequate. ↗
▶ Ep 7 · 24:00
epidemiological Extracorporeal stapled anastomosis for right hemicolectomy achieved a leak rate of 0.8% over 1000 cases at Cleveland Clinic. ↗
▶ Ep 7 · 24:56
guideline Genetic assessment is indicated for colorectal cancer patients with Bethesda criteria risk factors, cancer under age 40, first-degree relatives with cancer, or multiple cancers in the family. ↗
▶ Ep 7 · 25:33
clinical Genetic diagnosis affects both family screening recommendations and surgical approach; patients with hereditary syndromes may require subtotal colectomy or proctocolectomy rather than segmental resection. ↗