People with a high risk of bowel cancer can benefit from a new technique that could spare them major, life-changing surgery and the inconvenience of having to carry a stoma bag.
The procedure, which is a world first, involves removing large growths from the bowel in a far less radical fashion than is currently performed.
These tube-like growths, called polyps, form on the lining of the large bowel, also known as the rectum.
They are common, affecting 15 to 20 per cent of Britons, and they don’t usually cause symptoms. But they can become cancerous – so if they are discovered, they must be removed.
People with a high risk of bowel cancer can benefit from a new technique that could spare them major, life-changing surgery and the inconvenience of having to carry a stoma bag (stock image)
Usually, polyps are small and are burnt or cut away during a colonoscopy procedure, via a thin flexible tube passed into the back passage.
However, in about one per cent of patients they can grow to a very large size, sometimes covering the entire circumference of the rectum.
Not only does this cause bleeding, but removing these larger polyps means cutting away a significant part of bowel wall, and stitching it back together.
This creates a permanent narrowing, which means the bowel cannot function properly, and waste may be blocked.
In order to save these people from developing bowel cancer, they are advised to have an operation to remove the rectum completely – leaving them with a permanent external collection bag, or stoma. This is major surgery from which it can be extremely difficult to recover, especially in elderly patients with other health conditions.
Now, London-based surgeons have pioneered a new, far less invasive technique that enables even very large polyps to be removed.
Called TASER (transanal submucosal endoscopic resection), it has been developed by doctors at London North West Healthcare NHS Trust, and more than 40 patients have already been treated successfully. Instead of needing a major operation and permanent stoma, the patient stays in hospital for just a couple of nights.
The breakthrough is a huge step forward, said consultant colorectal surgeon Janindra Warusavitarne at St Mark’s Hospital in London. Mr Warusavitarne, who has pioneered the technique with his colleague Professor Brian Saunders, added: ‘Until now, patients with large, benign polyps were left with a stoma due to a condition that was exactly that – benign – and something that wasn’t yet life-threatening. If, on the other hand, you have advanced cancer, you can argue there is a clear benefit for having radical surgery.’
Now, London-based surgeons have pioneered a new, far less invasive technique that enables even very large polyps to be removed (a diagram explains the procedure above)
In the new procedure, in which two doctors operate at the same time, the patient is given a general anaesthetic before a tube is inserted into the rectum, through which the surgical instruments can be introduced.
The rectal wall is made up of four layers: the lining, or mucosa, which produces a slippery, gel-like substance call mucus to helps waste move smoothly through the tract; the submucosa, which houses the blood vessels and nerves; and beneath these the muscular layer, then a fatty layer. Previously, surgery would have involved cutting away all four layers. But during the TASER procedure, fluid is injected beneath the submucosa, lifting it away from the muscle.
The polyps grow from these upper layers, and surgeons are able to cut them away while leaving the lower layers intact.
One doctor operates instruments that grab the polyp, moving it to expose the base, while another uses cutting tools to carefully remove the growth. No stitching is required, and the mucosal layers are able to regenerate without forming inflexible scar tissue. After healing, the rectum functions normally, with bowel habits returning to normal after about six weeks.
Mr Warusavitarne said: ‘Before, we would have removed so much of the rectum wall that it would have made functional tasks, such as going to the loo, either very painful or impossible. Now we can remove even large polyps intact.’
The technique is being used in one other UK hospital – East Kent University Hospital Foundation NHS Trust – and research shows that it is successful long-term, and low-risk.
Indeed, one study by the team, published by the British Medical Journal, reported no episodes of severe bleeding after surgery, which can be fatal, and nor had there been any recurrence of polyps six months later.
One patient who has benefited from the pioneering treatment is Paul Eshelby, 65, a musician from Battle in Sussex.
After returning a bowel cancer screening sample in 2013, he was told there was a problem.
A colonoscopy later revealed a large growth which needed to be removed. He saw Prof Saunders and, using TASER, they removed the growth completely.
‘My consultant told me that this operation didn’t exist a few years earlier, so I’d have needed a bag,’ says Paul.
‘I’m so grateful to the team, and feel incredibly lucky.’
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