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KURIKULUM VITAE

 Nama

: dr. P. Sutamto Wibowo,
SpBKBD
 TTL
: Bondowoso, 20 Januari 1943
 Lulus dokter : thn 1967 FK UNAIR
 Lulus Ahli Bedah: thn 1974 FK UNAIR
 Brevet Ahli Bedah Digestif 1985 di
Surabaya
 Jabatan saat ini: Staf Bag. Bedah FK
UNAIR – RS dr. Soetomo Surabaya

CARCINOMA COLON
RECTUM
SURGICAL ASPECT

PAULUS SOETAMTO
WIBOWO

000 in countries (1990) .13 60.000 NEW CRC/YEAR Colon and rectal cancer age standarized incidence Rates per 100.000-30.40 44.01 29.11 40.70 22.of Korea Malaysia Phillipine Vietnam Papua New Guinea MALES FEMALES ASR 65.66 74.34 15.INCIDENCE CANCER COLON RECTUM COUNTRIES Australia New Zealand Japan Hongkong Singapore China Rep.51 60.08 Indonesia  22.65 29.71 15.

Asc C.5) 5 (4.2) 12 (9.0) 12 (9.3) 19 (15.1) 41 (20.4) 10 (10.3) 124 .9) 144 (73.2) 53 (52.1) 13 (9.Desc Sigmoid Rectum 3 (3.2) TOTAL 92 3 (1.LOCATIONS OF CANCER COLON RECTUM INDONESIA LOCATION SUMANTI WARTATMO PHILLIPPI SUDJATMIKO MANADO JOGJAKARTA JAKARTA SURABAYA 1990-1995 1994-1996 1991-1993 Caecum C.9) 15 (16.8) 5 (5.0) 8 (6.Transv C.9) 3 (3.3) 9 (9.5) 196 29 (25) 11 (10) 17 (15) 23 (20) 34 (30) 8 (6.3) 50 (54.3) 81 (65.0) 6 (15.5) 8 (4.6) 114 131 SUDARSA DENPASAR 1990-1995 5 (4.

SURVIVAL CARCINOMA COLON RECTUM  USA : 5YSR st I/II (37%) 90 % st III 65 % st IV 8% SURABAYA 5YSR 50 % SEMARANG 5YSR st I/II 70 %  RECURRENT   – – – – 80 % WITHIN 2 YEARS HEPATIC 50 % LUNG 20 % LOCAL 33 % PERITONEAL SEEDING 22 % STATISTIC USA 2001 AMERICAN CANCER SOCIETY .

Colon Resection  Total resection Negative proximal distal radial  Extended lymphadenectomy  Reanastomosis end to end .

COLON RESECTION ARTERIAL & LYMPHATIC DRAINAGE .

COLON RESECTION VENOUS DRAINAGE .

COLON RESECTION .

COLON RESECTION PREOPERATIVE  NUTRITIONAL STATUS  BOWEL STERILIZATION .

COLON RESECTION RIGHT COLON :  DUODENUM  RIGHT URETER  RIGHT GONAD VESEL  LEFT COLON :  LEFT URETER  LEFT GONAD VESEL  SPLEEN  “END TO END” ANASTOMOSE “NO TENSION” T4 --.“ en bloc “ resection “ No touch technique “ .

.

BOWEL OBSTRUCTION  LAVAGE INTRA OPERATIVE  LEFT COLON IN DOUBT HARTMANN / ILEOSTOMY .

TME Bladder Penis Prostate Sacrum Anus Rectum Coccyx .

Surgical TME technique of APR "coning in" Cilindrical resection .

CARCINOMA RECTUM   PREVENTION OF LOCAL RECCURENCE QUALITY OF LIFE (SOCIAL LIFE)  MULTIMODALITY COMBINED THERAPY (MCT)  TOTAL MESORECTAL EXCISION (TME)  SPHINCTER SAVING PROCEDURE (STAPLES) .

CARCINOMA RECTUM TOTAL MESORECTAL EXCISION 1982 HEALD (GREAT BRITAIN)  METASTASE LATERAL (RADIAL) > DISTAL  TME  2 CM DISTAL STUMP SPHINCTER SAVING (FROZEN SECTION)  PRESERVE AUTONOMIC NERVE  BOWEL. BLADDER. SEXUAL FUNCTION .

Norwegian Rectal Cancer Project N = 3319 Conventional surgery TME Local recurrence 12% 6% Overall survival 60% 73% Wibe et al. Dis Colon Rectum 2002. 45:857-66 .

TOTAL MESORECTAL EXCISION .

TOTAL MESORECTAL EXCISION .

TOTAL MESORECTAL EXCISION .

CARCINOMA COLON RECTUM REANASTOMOSIS .

CARCINOMA COLON RECTUM  PREOPERATIVE CHEMORADIATION MULTIMODALITY THERAPY ?! 4-6 wks 3-6 wks CHEMORADIATION 5FU + LEUCOVORIN 4000cGY  DOWN STAGING   RESECTABILITY  LOCAL RECURRENCE  SURGERY CHEMORADIATION .

PREOPERATIVE ASSESSMENT OF RECTAL CANCER ANTERIOR RESECTION > 15 CM 10-15 CM PARTIAL TME CLINICAL T1 N0 M0 CLINICAL T2 N0 M0 1-10 CM CLINICAL T3 N any M0 CLINICAL T4 N any M0 <1 CM LOCAL EXCISION TME PRE-OP CHEMORADIATION CHEMORADIATION + TME POST-OP CHEMORADIATION PRE-OP CHEMORADIATION + APR APR .

CARCINOMA COLON RECTUM FUTURE LAPAROSCOPY  CHEMOTHERAPY  BIOMOLECULAR – THERAPY  SCREENING .DIAGNOSTIC  .

CONCLUSION SURGICAL AUDIT  TO IMPROVE SURVIVAL   IMPROVE SURGICAL TECHNIQUE  CHEMORADIATION PERIOPERATIVE  REFER TO A BETTER CENTRE .