Marisa Domingues dos Santos

By Marisa D. Santos

Restorative proctocolectomy with ileal pouch-anal anastomosis (RPC-IPAA) is a surgical procedure performed when excising the entire colon and rectum is need and reconstitution of the intestinal transit through an ileal pouch is made with anastomosis to the anus. It is mainly used to treat patients with familial adenomatous polyposis (FAP) and ulcerative colitis (UC). It is a complex surgery with potential complications, and the functional outcomes can be worse over time. So, it is essential to select the appropriate patient, proceed to a correct surgical technique, and know-how to deal with and solve the main ileal pouch complications. This chapter intends to be a reflection on this subject.

Part of the book: Current Topics in Colorectal Surgery

By Pedro Nuno Brandão, Lúcia Lacerda and Marisa D. Santos

Colorectal cancer is the fourth most frequently diagnosed cancer and one of the leading causes of cancer death around the world. Patients with locally advanced rectal cancer are treated with a combination of radiotherapy, chemotherapy, and surgery. Treatment response can be quite variable—some with complete response, while others show little or no response—and pathologic response has become a significant predictor of good oncologic outcome. The knowledge of the molecular pathways in colorectal cancer is increasing. However, unfortunately, it still fails to find some more precise method to select and tailor patients to different treatment approaches and overcome treatment resistance. Recent investigations showed that sphingolipids play an essential role in cancer biology and can influence treatment response and aggressiveness. It is of utmost importance to understand sphingolipids’ metabolism in colorectal cancer and how it affects tumor biology and response to treatment.

Part of the book: Recent Understanding of Colorectal Cancer Treatment

By Marisa Domingues dos Santos

Colorectal surgery has undergone an enormous technical evolution with the advent of laparoscopy and, more recently, the robotics approach. Technology, combined with the use of more advanced materials and the implementation of pre-habilitation and enhanced recovery after multimodal surgery programs, has allowed the performance of complex surgeries with excellent results. As a result, reaching optimal oncological, physiological, and cosmetic results associated with the patient’s better and shorter postoperative stay is possible. However, colorectal anastomosis is still a critical aspect of this process that always affects the final result of the surgery. Therefore, it has profound implications in the short, medium, and long term. When an anastomotic leak occurs, it is usually the surgeon’s biggest nightmare and can have devastating consequences for both the patient and the surgeon. This chapter’s aim pretended to reflect on how to avoid colorectal anastomotic leakage and, if it happens, how to detect and treat it early, trying to minimize the number and the consequence.

Part of the book: Current Concepts and Controversies in Laparoscopic Surgery

By Mónica Sampaio and Marisa D. Santos

Although the incidence of acute diverticulitis (AD) has risen over the past few decades, particularly in younger patients, the rate of emergency surgery has been dropping due to a major paradigm shift toward more conservative management approaches. The long-term management strategy after successful nonoperative treatment of AD remains unclear, and indications for elective resection are a matter of ongoing debate. Most modern professional guidelines advise considering elective surgery in an individualized approach, particularly after recovery of acute complicated diverticulitis (ACD) with abscess and in patients with recurrence, persisting symptoms, and complications such as abscess, fistula, and stenosis, focusing on the patient’s quality of life, where recurrence, severity, and symptoms are major determinants. However, guidelines are still not clearly standardized for appropriate decision-making, with patients being managed very differently from institution to institution, and surgeon to surgeon, mainly due to a lack of risk stratification for recurrence and severity that have been the scope of numerous studies but still need to be clarified. In this chapter, we explore the current surgical indications for AD, considering this disease’s ongoing prognostic factors, for proper decision-making.

Part of the book: Diverticular Bowel Disease