7th Biennial Congress of the Mediterranean Society of Coloproctology (MSCP), Thessaloniki, Greece, April 22–24, 2010

Abstract

I attended a well-organized meeting, with the participation of many speakers from Greece, from the Mediterranean area and from several European countries, despite the ashes of the Icelandic volcano. Topics included the most relevant aspects of coloproctological research. A friendly but frank atmosphere has characterized the comprehensive discussion in every session. The optimal diagnostic work-up of rectal cancer was stressed. Endorectal ultrasound can accurately predict T stage in more than 90% of cases, but it is poor at identifying the N stage. CT is useful for locally advanced tumors in identifying adjacent organ involvement, but it cannot accurately evaluate the T stages. MRI is able to accurately predict T stage in 50–90% of patients but is the most reliable tool to detect the circumferential margin involvement. Accuracy in identifying peritoneal tumor perforation and venous invasion is up to 80 and 83%, respectively (M.G. Pramateftakis, I. Kanellos). Total mesorectal excision is the gold standard in the treatment of rectal cancer. Additionally, high ligation of colonic arteries and complete mesocolon excision was presented as the optimal surgical technique of right hemicolectomy for colon cancer (M.G. Pramateftakis). Minimally invasive local excision techniques can be applied for early T1 and T2 rectal tumors smaller than 4 cm, involving less than 40% of the lumen circumference, in patients with significant comorbidities to undergo a radical procedure, in symptomatic patients with multi-organ distant metastatic disease and in well-informed patients denying a radical procedure or a stoma (K. Tepetes). Leakage of colonic anastomosis is the most serious complication after colon resection. Early diagnosis and treatment is imperative; minor leaks can be treated conservatively with parenteral nutrition and antibiotics, while operative treatment is needed for major leaks defined by symptoms of peritonitis and septicemia (D. Kanellos). Loco-regional recurrences of colon cancer (tumor bed, regional nodes, adjoining structures or organs, anastomosis, peritoneum, retroperitoneum, pelvis and surgical scars) after curative colon cancer range between 11 and 40% and are responsible for 30% of deaths. The ideal treatment is the complete resection of the recurrence tumor to achieve R0 operation that provides significant long-term survival (A.N. Machairas). GISTs are the most common mesenchymal gastrointestinal tumors. The most common sites are the stomach and the small bowel. Colorectal GISTs represent 5–10% of the cases, with rectum being the most common site. Segmental colectomy is the mainstay of treatment for resectable nonmetastatic primary colorectal GIST. Since GIST do not metastasize through lymphatics, lymphadenectomy and mesorectal excision are not necessary. Unresectable tumors could be downstaged with neoadjuvant treatment and restaged for respectability (A. Amato). Firstand second-degree hemorrhoids should be treated conservatively. Stapled hemorrhoidopexy is indicated for third-degree hemorrhoids. The technique is questionable for fourth-degree hemorrhoids, showing a higher long-term recurrence rates than excisional surgery (I. Kanellos, X. Delgadillo). Obstructed defecation affects nearly 50% of constipated patients. Symptoms include incomplete and frequent evacuations, straining at stool, self-digitation, perineal and pelvic heaviness, long time spent in toilette. Rectocele and rectal mucosal prolapse are the most common findings, E. Yiannakopoulou (&) Faculty of Health and Caring Professions, Technological Educational Institute of Athens, Athens, Greece e-mail: nyiannak@teiath.gr