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Lower gastrointestinal tract

Team of doctors:
Priv.-Doz. Dr. Reinhold Kafka-Ritsch
Priv.-Doz.in Dr.in Pamela Kogler
Dr. Stefan Scheidl, FEBS

Special consultation hour:
Thursday 09:00 - 14:00
Tel. +43 (0)50 504 50010

The gastrointestinal oncology department deals with the diagnosis and treatment of malignant tumors (cancer) of the gastrointestinal tract (stomach, small intestine, large intestine and rectum), the peritoneum (peritoneum) and sarcomas (malignant soft tissue tumors) of the abdominal cavity.

Colon carcinoma (cancer of the colon)

In Tyrol, about 400 patients per year are diagnosed with colon or rectal cancer, which is why these tumors are among the most common "surgical" tumors, along with lung, prostate and breast cancer. If a colon carcinoma is diagnosed during a colonoscopy (colonoscopy), further examinations (primarily a computer tomography) are performed to determine the stage of the disease more precisely. Subsequently, each patient with colon cancer is discussed in our interdisciplinary gastrointestinal tumor conference to determine an optimal treatment plan individually for each patient. Depending on patient-related and tumor-related factors, the surgery required in most cases is performed either conventionally by means of an abdominal incision or minimally invasively by means of laparoscopy, but in any case according to the internationally valid radicality principles. Today it is known that in the case of colon cancer, both surgical methods are equivalent in terms of chances of recovery, with slight advantages of the laparoscopic method for immediate recovery after surgery. At our clinic, both methods are combined with the modern principles of "Optimized Perioperative Treatment" ("Fast track surgery"), a strategy designed to minimize the stress and strain of surgery. A basic principle here is, for example, the only short-term interruption of normal nutrition during intestinal surgery. In the case of small and early diagnosed colon carcinomas, limited surgical procedures can also be used in case of precisely defined constellations of findings, so that a major bowel operation can be avoided. Whether chemotherapy is necessary after or, in selected cases, before surgery is decided jointly in our interdisciplinary gastrointestinal tumor conference. All patients operated on at our clinic are checked in the consultation hours for gastrointestinal tumors, initially every 3 months, then every six months and later annually. ACO-ASSO (Austrian Society for Surgical Oncology), AG Colon/rectum/anus: Link

Rectal carcinoma (cancer of the rectum)

Although almost all the aspects described for colorectal cancer are also true for rectal cancer, there are some differences that are primarily related to the location of the rectal carcinomas in the "narrow" bony pelvis, especially if they are close to the anus. In order to be able to assess the extent of the tumor in the pelvis, magnetic resonance imaging (MRI) must be performed in addition to the usual diagnostic procedures. If the MRI shows a locally advanced stage, today a combined radiation-chemotherapy (radiochemotherapy) is standard and only secondary the operation is performed. Together with the precisely performed surgical technique ("total mesorectal excision", TME), the "local recurrence", which was very common in earlier years, has now been significantly minimized. This treatment concept has been performed at our clinic for 15 years, which has led to excellent results in terms of local recurrence and long-term survival in international comparison. The tumor board decides which patients will primarily undergo radiation chemotherapy, and despite the most modern techniques, we have to apply a permanent "artificial juicer" (stoma) in about 10% of our patients with rectal cancer. These patients are already informed in detail by us and by specially trained "stoma nurses" of our stoma outpatient clinic before the planned operation and are permanently cared for after the operation.in the treatment of patients with rectal carcinoma, the preservation of the quality of life is of decisive importance in addition to healing. This important goal is especially taken into account during the aftercare examinations in the consultation hours for gastrointestinal tumors. ACO-ASSO (Austrian Society for Surgical Oncology), AG Colon/rectum/anus: Link

Metastases in colon and rectal carcinoma

Even if the cancer of the colon or rectum has already spread to other organs (liver, lungs, ...), i.e. has metastasized, in many cases a cure can be achieved through surgery. Our clinic has decades of experience in liver and lung surgery and the possibility of hyperthermic intraperitoneal chemotherapy (HIPEC) for peritoneal carcinoma (see peritoneal tumors). However, metastasis surgery is not oncologically useful in every constellation of findings, or the general state of health of the affected patient is not suitable for aggressive surgical therapy, so that appropriate patient selection plays a significant role in the success of this type of surgery. It is precisely for this reason, but also due to rapid developments in the field of drug therapy options, that we discuss every patient with metastases in the interdisciplinary gastrointestinal tumor conference. Embedded in pre-operative (before surgery) and/or post-operative (after surgery) therapy concepts, we at the University Clinic for Visceral, Transplant and Thoracic Surgery in Innsbruck perform all procedures necessary for the optimal treatment of patients with liver metastases, lung metastases and peritoneal carcinomatosis. In our experience, the long-term results obtained in this prognostically unfavorable patient group seem to be superior to the purely palliative systemic therapy alone - identical to the data in the literature.

Peritoneal malignancies (malignant tumors of the peritoneum)

Malignant tumors of the peritoneum are divided into tumors that primarily originate from the peritoneum and tumors that secondarily affect the peritoneum as metastases (peritoneal carcinomatosis, e.g. in colon or stomach cancer). Especially tumors of the appendix (appendix, often called "appendix") show relatively often an infestation of the peritoneum. The only curative treatment for these aggressive tumors is a combination of surgical removal of all visible tumor nodes and chemotherapy in the abdomen during surgery (hyperthermia intraperitoneal chemotherapy, HIPEC). This chemotherapy is administered at about 42°C, because its effectiveness is increased. Often the operation is accompanied by multivisceral resections (removal of several organs) and removal of parts or all of the peritoneum (peritonectomy) in order to achieve the goal of radical tumor removal. As the largest peritoneal carcinoma center in Western Austria, we have been performing this highly specialized treatment since 2006. All patients operated on at our center are checked in our gastrointestinal tumor clinic, initially every three months, then every six months and later annually. ACO-ASSO (Austrian Society for Surgical Oncology), AG Peritoneal Malignancies: Link

Abdominal (intra- and retroperitoneal) sarcomas

Soft tissue sarcomas are a heterogeneous group of malignant tumors, accounting for approximately 1% of all malignant tumors. In diagnostics, computed tomography and magnetic resonance imaging are particularly helpful. Optimal diagnostics as well as interdisciplinary therapy planning in the tumor board are essential for the success of a treatment that focuses on radical surgery. This often requires extensive surgery, often involving the removal of several adjacent organs. However, the long-term success of such an operation can only be achieved by combining it with other therapies (radiotherapy, chemotherapy). The planned and correctly performed tissue removal (biopsy) before the start of therapy (in order to have an exact fine tissue diagnosis), the intraoperative frozen section examination as well as the intraoperative radiotherapy play a decisive role. In the case of retroperitoneal sarcomas (sarcomas in the posterior abdomen), surgery should always be performed in readiness for intraoperative radiotherapy. All patients operated on by us are checked in the consultation hours for gastrointestinal tumors, initially every 3 months, then every six months and later annually.

Familial (hereditary) tumors of the gastrointestinal tract

Changes in the genetic material ("mutations"), which is located in the genes in the cells, play a decisive role in the development of tumors. If stomach or colon cancer occurs in a family of blood relatives or at an unusually early age, it is advisable to carry out certain genetic tests on blood samples from the patient and his or her relatives in order to assess the risk of developing a tumor in the family members. It may also be useful to search for gene mutations in tumor tissue after tumor surgery in order to predict whether or not a particular drug treatment is appropriate. In cooperation with the Section of Clinical Genetics and the Institute of Pathology of the Medical University of Innsbruck, we offer these tests to our patients. Section of Clinical Genetics, special consultation hour for tumor disposition diseases: http://www.i-med.ac.at/humgen

Chronic inflammatory bowel diseases (Crohn's disease - ulcerative colitis)

Conservative or drug therapy is the central component in the therapy of chronic inflammatory bowel diseases. Approximately 50% of patients suffering from chronic inflammatory bowel disease require surgical intervention during the course of the disease. The necessity or sense of a surgical intervention and, above all, the "timing" of an operation is decided on an interdisciplinary basis between gastroenterologists, surgeons and, above all, the patient. For all elective surgeries, i.e. those planned in the inflammation-free interval, a precise preoperative clarification and definition of the surgical strategy is essential. A well informed patient, who understands the necessity of the operation and the operation strategy, contributes significantly to a better result and a course without complications. Furthermore, preoperative optimization of the nutritional status and immunosuppression is important.

Emergency surgery: In case of bleeding, perforation (intestinal rupture), severe colitis with sepsis or intestinal obstruction, only emergency surgery can defuse the life-threatening situation.

Planned (elective) surgery: The most common indication for elective surgery is so-called therapy-refractory disease, i.e. disease that does not respond adequately even after all conservative treatment measures have been exhausted.

Surgical therapy is also indicated in any suspected case of malignant degeneration of the disease, i.e. already in the presence of high-grade dysplasia in the colon or in the suspected malignant degeneration of a fistula in Crohn's disease.

Surgical strategy: While the aim in Crohn's disease must be segmental surgery with as little bowel involvement as possible, in ulcerative colitis the aim is usually complete removal of the colon.

In most cases, however, it is possible to preserve the function of the sphincter muscle by means of an ileum pouch with colo-anal anastomosis. Especially for first-time operations, the operation is performed at our center laparsocopically, i.e.: in the sense of keyhole surgery by means of a few small incisions video-assisted. In addition to better cosmetic results, a faster convalescence and an improved body image can be achieved.

Diverticulosis - Diverticulitis

A diverticulum is a sack-shaped protrusion of the colon mucosa through the muscular intestinal wall, usually at the points where blood vessels pass through. Diverticulosis is the presence of diverticula without inflammation or symptoms. It occurs in up to 30% of the normal population and increases with age. Diverticulitis is the inflammation of a diverticulum, the symptoms vary according to the degree of inflammation. Mild episodes of inflammation with pain in the left lower abdomen, which respond well to conservative therapy such as dietary restrictions and antibiotic therapy, account for up to 75% of all episodes. Complicated forms requiring surgical therapy account for 25% of all episodes and range from abscesses requiring drainage, the formation of fistulas in other organs to severe peritonitis with life-threatening sepsis. Diverticular hemorrhage caused by the bursting of the vessel adjacent to the diverticulum usually stops spontaneously or can be stopped by intervention.

Surgery: Since emergency surgery is associated with many more complications and a significantly worse outcome, it is crucial to identify those patients for whom a planned operation can prevent such a course. Whereas until recently two episodes of diverticulitis in older patients and one in young patients were indications for sigmoid resection, the indication for surgical rehabilitation is now more restrictive and, above all, individualized. This means that 6-8 weeks after healing of the diverticulitis episode, the healing of the diverticulitis and the presence of further diverticula is determined by means of intestinal x-ray (irrigoscopy) and colonoscopy (colonoscopy). Subsequently, the further procedure is determined with the patient, taking into account the risk of the operation. Furthermore, we try to treat even complicated diverticulitis episodes as far as possible without laparatomy, in order to be able to perform the intestinal resection under elective conditions with optimal preparation of the patient and minimally invasive.

Surgical technique: Elelective bowel resections due to diverticulitis are performed at our center using minimally invasive techniques using laparoscopy and the modern "fast track" concepts of optimal perioperative treatment. Even in acute operations, which are unavoidable in cases of generalized peritonitis, our center tries to restore intestinal tract patency, i.e. not to create a temporary artificial bowel outlet. This is often achieved by using "Abdominal VAC dressing", an open abdominal drainage for the treatment of peritonitis.