On Friday 27 September, the final day of ESCP’s 14th Annual Meeting in Vienna, Des Winter (UK) and Gregor Norcic (Slovenia) chaired the symposium session ‘Strategies for managing locally advanced colonic cancer’ in the main auditorium.

Petr Tsarkov giving Open surgery presentationFour speakers from around the globe gave insightful and educational presentations to a packed auditorium regarding their respective specialist areas.

Ivon Dimitrijevic (Serbia) kicked things off with a discussion regarding the various staging challenges of colonic cancer.
Is it T4a? T4B? ‘High Risk T3’ - more than 5mm beyond muscularis propria? Ivon noted such challenges with identification and correlating the appropriate course of treatment. He went on to discuss relevant research papers which primarily focused on the role CT plays. He stated that preoperative colon cancer staging is based on MSCT and while local staging is still challenging, further studies and the introduction of other imaging modalities is required to progress at this point.

Next up was Brian Bird (Ireland) who discussed chemotherapy. He ran through current treatments in relation to both colon and rectal cancer including the colon cancer adjuvant approach and the perioperative approach. He shared various patient case studies, prompting the audience to contemplate their preferred course of treatment, and discussed the results of the FoXTROT study which compared neoadjuvant/perioperative approaches.

He then discussed the possible innovations and speculations regarding the future of chemotherapy including whether or not electroporation can activate the immune system before surgery. This would be a game changer, along with new drugs that are not yet in trials.

Petr Tsarkov (Russia) took the stage next to speak about the advantages of open surgery and how patients with colonic cancer may receive better oncological results undergoing this procedure compared to laparoscopic or robotic surgery.
He called for more junior surgeons to undertake training in order to become proficient in it. Given that in recent years, the focus has primarily been on providing surgeons with training to learn minimally invasive techniques, it’s apparent there is a lack of surgeons who now specialise in this and yet some colon cancer patients require it.

Finally, Matt Albert (USA) delivered a presentation on MIS surgery as a strategy for managing locally advanced colonic cancer. He spoke about the necessary preoperative planning required to achieve R0 resection, with detailed video vignettes and multivisceral resection and its limitations.

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