Colon and Rectal Surgery Unit

Overview - Mission

The Colorectal Surgery Unit is committed to the comprehensive care and research of patients affected by colorectal cancer. Its mission is to deliver the highest standards of curative treatment—aiming for definitive recovery—while preserving patients’ quality of life. This is achieved through multidisciplinary protocols and close, ongoing clinical and scientific collaboration with medical oncologists, radiation oncologists, radiologists, endoscopists, pathologists, and the Institute’s nursing staff.

As part of the Fondazione IRCCS Istituto Nazionale dei Tumori in Milan, the Unit serves as a national and international referral center for the surgical treatment of both primary and recurrent colorectal cancers. The Unit specializes in minimally invasive surgical techniques: currently, approximately 75% of procedures are performed using laparoscopic, robotic, or transanal approaches. These techniques minimize surgical trauma and promote faster postoperative recovery.

All surgical candidates undergo a preoperative management process, which includes prehabilitation programs when indicated. These programs encompass nutritional evaluation, correction of neoplasm- related anemia, and psychological support as needed.

The Unit is also dedicated to the multidisciplinary assessment and care of elderly and frail patients. These patients benefit from a preoperative multidimensional evaluation, often in collaboration with a geriatrician, allowing the integration of minimally invasive surgery with Enhanced Recovery After Surgery (ERAS) protocols. This approach supports faster convalescence and the maintenance or recovery of functional independence. Notably, the Unit is among the lead promoters of the international HOPE study (Health Outcome Prioritization to Elicit the Preferences of Older Patients with Cancer), which investigates clinical and oncological priorities among elderly cancer patients undergoing major surgery.

Recently, the Unit has redesigned its Diagnostic and Therapeutic Pathway (PDT) for colorectal cancers, enhancing service quality and reducing waiting times for diagnostics, multidisciplinary evaluations, and hospital admissions. A key example is the “Global Rectum Project,” which integrates clinical care and research to optimize recovery outcomes and quality of life. Key components include:

- Weekly Multidisciplinary Case Discussions: Each new case is reviewed by the Colorectal Tumor Board, composed of dedicated specialists including surgeons, oncologists, radiologists, pathologists, and endoscopists. Treatment plans are personalized in accordance with national (AIOM) and international (ESMO, NCCN) guidelines;

- Multidisciplinary Patient Consultations: The Tumor Board’s decisions are communicated to patients during coordinated outpatient visits attended by the relevant specialists. For rectal cancers, neoadjuvant therapy (typically a combination of chemotherapy and radiotherapy) is often recommended prior to surgery to maximize therapeutic outcomes and, where appropriate, to pursue non-operative management (Watch and Wait);

- Minimally Invasive Surgical Approaches: Whenever feasible, the Unit employs laparoscopic and robotic techniques to enhance postoperative recovery, including earlier mobilization, improved nutrition, and shortened hospital stays;

- Individualized Reconstructive Surgery for Low Rectal Cancers: Reconstructive pathways aim to achieve complete oncological resection while maximizing sphincter preservation and avoiding permanent stomas;

The Unit's medical team consists of a Director, nine attending surgeons, and four medical researchers—all with substantial clinical and research experience. Surgical residents from the University of Milan rotate through the Unit on a semi-annual or annual basis.

The nursing and support team includes a coordinator, fourteen nurses, and six healthcare operators who provide continuous, round-the-clock patient care. A specialized stoma nurse is available daily from 8:30 AM to 2:30 PM for stoma care, dressing changes, counseling, and education for patients and caregivers. The team is supported by an administrative secretary.

The inpatient ward, certified under ISO 9001 standards, comprises twelve double-occupancy rooms, each with a private bathroom. The Unit represents a high-volume, tertiary referral center at the national level, managing over 500 patients and performing approximately 400 colorectal cancer surgeries annually.
Post-treatment, all patients are enrolled in a dedicated outpatient follow-up program to monitor for recurrence. Stoma patients receive specific long-term management support. Where feasible, follow-up consultations and care may be delivered via telemedicine, particularly for those living at a distance.