Keyhole idea could end misery of bowel cancer operations

British breakthrough will stop part of intestine being removed

ANEW operation to remove colon polyps could save thousands of bowel-cancer patients from having a large part of their intestine removed. About 1,000 people in the UK have surgery to remove up to a third of their colon due to potentially cancerous colonic polyps, and nearly 40 per cent suffer post-op complications, including heart attacks and lung clots.

The new minimally invasive procedure, developed by a British surgeon, could eliminate the need to remove part of the colon by instead cutting off only the affected area during keyhole surgery.

About a fifth of Britons have polyps – growths on the inner lining of the colon or rectum – and while most are benign, causing at worst rectal bleeding, diarrhoea and stomach ache, ten per cent are cancerous.

Due to the high cancer risk, polyps are almost always removed. In most cases, this requires only a colonoscopy, when a camera is passed through the rectum and into the bowel and the polyp is either cut off or burnt off.

But in some cases, when the polyp is too large or is malignant, patients undergo a segmental colectomy in which part of the colon is removed. Often, as much as a third of the bowel – most of which is healthy tissue – is taken away and the remaining bowel is joined back together.

Each year in the UK some 1,000 people with benign polyps have segmental colectomies, and about 40 per cent suffer complications, which include leakage from the join, heart attacks, lung clots, loss of normal bowel function and infection. There is also a two per cent risk of death.

But the new FLEX – full thickness laparoendoscopic excision – technique, which has been developed at St Mark’s Hospital in Harrow, North-West London, means a folded disc of the colon containing the polyp or tumour can be removed with keyhole surgery under general anaesthetic. It is hoped it will bring the risk of complications down to between five and ten per cent. The patient’s stay in hospital is expected to reduce from between four and seven days for a colectomy to one or two days for FLEX.

The surgeon is guided through the colon with the help of an endoscopist operating a camera, after which stitches and clips are used to create a pleat that completely contains the polyp. The technique is so precise that no bugs or malignant cells are released into the peritoneal cavity before the pleat is removed entirely.

Senior colorectal consultant Professor Robin Kennedy, who is ready to start teaching the procedure at St Mark’s and around the country, said: ‘We don’t want to be doing unnecessary colectomies for benign polyps. FLEX means patients don’t lose healthy tissue, and the operation could be done in less than an hour, compared to two to three hours for a colectomy.’

One of the first patients was Griffith Chanot, a retired electronics design engineer from Ickenham, Greater London. Mr Chanot, 83, underwent FLEX in May 2015 after a colonoscopy revealed three polyps, one of which was becoming cancerous.

‘It seemed like a straightforward staple-and-snip procedure and it worked like magic,’ said Mr Chanot. ‘I had a few little marks on my stomach where they went in for keyhole surgery, but they healed quickly. I liked it because it was minimal intervention and everything went back to normal within a few days.’

Prof Kennedy believes the technique will in time also be suitable for people with early bowel cancers that are smaller than 3cm in diameter and confined to the inner lining of the bowel. Up to 4,000 patients per year in England fall into this category.

‘Only one in ten patients with early bowel cancer need to have their lymph nodes removed and have a segmental colectomy,’ explained Prof Kennedy. ‘If we can predict which patients need lymph nodes removing, then the other 90 per cent could undergo a FLEX procedure.

‘Within three to five years, we’ll be starting to think about local excision for these early cancers.’