The activities of the 3rd semester of the Master's Degree also include a two-day educational program-practical training, in collaboration with some centers-organizations based in Athens:
The non-profit organization NoDE Institute.
The ELPEN research-educational-experimental center in Pikermi, Attica.
The purpose of the training program is to provide the participants of the Postgraduate Program with sufficient experience to perform laparoscopic colorectal surgery. The training is conducted on animal models or fresh human cadaveric specimens and includes the performance of laparoscopic colectomies by the participating surgeons.
Learning outcomes
Upon successful completion of the internship, students will have been trained to perform the following procedures: 1. right colectomy 2. left colectomy 3. low anterior rectal resection 4. enterectomy 5. laparoscopic anastomosis 6. transanal techniques
1. Metastatic disease from colon cancer strategy (liver first?, intestine first?, both together?) by whom? 2. Peritoneal carcinomatosis in colon cancer
Learning outcomes
Upon completion of the course, students will have acquired specialized knowledge regarding the treatment options for metastatic disease from colorectal cancer. The most recent data applicable to the treatment options for metastatic liver disease will be presented, while surgical options for peritoneal carcinomatosis in colorectal cancer will be presented.
1. Clinical picture – diagnosis – endoscopic treatment – does it have a place? 2. Imaging – staging 3. Restaging after neo adjuvant 4. Neoadjuvant treatments: Radiotherapy (before vs after, short vs long regimen) 5. Chemotherapy – does it have a place? 6. Time / planning of surgery after neo adjuvant 7. Anal cancer 8. Interventional options depending on the location of the tumor 9. Watch & wait tactic – does it have a place? 10. Less (local) excision – has a place 11. Surgical treatment of rectal cancer: the importance of TME/laparoscopic vs open vs robotic 12. Abdominal perineal resection of the rectum – when and how? 13. Adjuvant therapy: to whom, what and for how long 14. Management of oligometastatic disease – management of recurrence 15. Evaluation of the rectal resection preparation: macroscopic, microscopic
Learning outcomes
Upon completion of the courses in this specific module on rectal cancer, students will have acquired specific knowledge regarding the clinical presentation, diagnosis and endoscopic management of rectal cancer. This module will present the specifics in the staging of patients with rectal cancer and will present comparative results between the imaging methods currently used for the local staging of rectal cancer. In this section, students will learn about the role of imaging methods in the restaging of patients with rectal cancer after neoadjuvant treatment. Those neoadjuvant treatments that involve radiotherapy will also be presented and data on the timing of administration will be analyzed. The advantages and disadvantages of radiotherapy regimens will also be analyzed. The most recent data on the administration of chemotherapy preoperatively will be presented and it will be clarified whether chemotherapy has a place preoperatively in the treatment of patients with rectal cancer. Data on the planning and timing of surgery after neoadjuvant treatment will be presented. In this section, students will have acquired the most up-to-date knowledge about rectal cancer. Also, all the interventional options depending on the location of the tumor in rectal cancer will be presented and discussed. Students will have acquired knowledge about the wait-and-see strategy in rectal cancer and will be presented with the data that may substantiate this strategy as an acceptable therapeutic option for preserving the organ, while in the final part of the section, students will have obtained specific knowledge about the surgical techniques that are proposed and concern oncological surgery with simultaneous preservation of the rectum. At the end of this section, students will know all the data regarding the surgical treatment of rectal cancer through the model of total mesorectal resection, while the role of laparoscopic and robotic surgery and the results of their comparison with open surgery will be analyzed. Upon completion of the course, students will also have acquired specialized knowledge regarding the importance of adjuvant chemotherapy in patients with rectal cancer. It will be clarified which patients will benefit depending on the type of chemotherapy, while the management of oligometastatic disease as well as the therapeutic strategy in case of disease recurrence will be analyzed. In this module, students will receive specialized knowledge regarding the pathoanatomical methods of evaluating the surgical preparation in rectal cancer. In the second part of the module, special topics in rectal cancer will be discussed regarding the management of local recurrence and surgical resection of the rectum beyond the limits of total mesorectal excision, while the most up-to-date data regarding transanal total mesorectal excision will be presented by distinguished speakers from abroad. At the end of the module, students will have acquired specific knowledge regarding the technical details of abdominoperineal resection of the rectum and transsphincteric low anterior resection, while they will have a complete picture of the functional problems after low anterior resection of the rectum.
1. Neo-adjuvant CMT: does it have a place in the colon? 2. Sporadic colorectal cancer. Clinical picture – Diagnosis 3. Imaging – staging 4. Endoscopic resection: does it have a place in the colon? 5. Bowel preparation: yes/no, when? mechanical cleaning, antibiotics 6. Problems with intraoperative localization of the lesion 7. Principles of surgical treatment: CME, CVL, extent of resection, colon vs. colonic / the number and importance of lymph nodes 8. Open or laparoscopic colectomy? 9. Location in the transverse colon – specifics Location in the rectosigmoid bend – colon or rectum? 10. Colectomy quality control – macroscopic examination – colectomy preparation evaluation 11. Monitoring of stage I and II patients: who monitors and for how long? What is monitored? 12. Factors (Immunoscore, MSI, etc.) that determine the selection of patients for adjuvant chemotherapy 13. Adjuvant chemotherapy after curative resection for colon cancer – stage II 14. Adjuvant chemotherapy after curative resection for stage III colon cancer Postoperative follow-up – management of patients with stage III disease
Learning outcomes
Upon completion of the course, students will have acquired knowledge about neoadjuvant chemotherapy in colon cancer and whether it has a place in clinical practice. The clinical picture and the diagnostic algorithm for colon cancer will be fully developed, while the role of radiological imaging methods in the preoperative staging of colon cancer will be clarified. At the end of the unit, students will have acquired knowledge about the role of endoscopic resection in colon cancer and whether it has a role in clinical practice. Also, in this unit, students will have acquired specific knowledge regarding the preparation of the colon before surgery for colon cancer. The role of mechanical preparation of the colon and its role in reducing the rates of surgical site infections will be thoroughly developed. The role of antibiotics in colon preparation will be emphasized and the most recent data on their role in reducing surgical site infections will be presented. This section will discuss the problems of intraoperative lesion localization in colorectal cancer and the role of preoperative marking and intraoperative endoscopy in lesion localization. In this section, students will have received detailed knowledge about the modern trend and oncological principles on which oncological surgery of the colon is based today. The basic principles of total mesenteric resection and its importance in the survival of patients with colon cancer will be presented. The results of the comparison of this method with more conventional methods regarding patient survival will also be presented. In this section, the most modern data regarding laparoscopic colon surgery and its comparison with open surgery for colon cancer will be presented. All the specificities regarding cancer of the transverse colon and the rectosigmoid flexure will be discussed and how this specific location can change the extent of surgical resection. This section will present all the data that applies to the postoperative monitoring of patients depending on the stage of the disease, will present the factors that determine the selection of patients for adjuvant chemotherapy and will highlight the importance of adjuvant chemotherapy depending on the stage of the disease in patient survival. The role of histopathological examination of the surgical specimen in assessing the quality of the surgical procedure and the detailed description of all data necessary for correct staging in identifying those patients who will benefit from receiving adjuvant chemotherapy will be highlighted. This section will conclude with the presentation of the specifics regarding the treatment of obstructive colon cancer and neoplasms of the appendix.
1. Gastrointestinal Developmental Biology 2. Biomarkers – molecular classification 3. "Liquid biopsy": methodologies, prognostic/predictive value, daily use 4. The role of microbial flora in carcinogenesis and response to treatment 5. Genetic syndromes. Classification, pathogenesis, counseling 6. Patient management, surveillance programs 7. Case presentation – biomarkers 8. Case presentation – genetic syndromes
Learning outcomes
Upon completion of the course, students will have learned the evolutionary biology of colon cancer. They will have acquired knowledge about the embryological development of the colon and the basic cellular regeneration pathways, the disruption of which will lead to the development of cancer. Students will have received important information about the basic pathways of colon cancer development through specific gene mutations responsible for both sporadic cancer and genetic syndromes associated with colon cancer. In this section, the importance of highlighting these specific mutations as prognostic biomarkers in the prognosis of patients with colon cancer through adjuvant therapeutic manipulations will be clarified. By the end of the course, students will have been informed of the most recent data on "liquid biopsy" and its prognostic and predictive value in daily clinical practice. Also, modern bibliographic data on the role of microbial flora in carcinogenesis and the role of the microbiome in the effectiveness of colon cancer treatment will be provided. In this section, a detailed reference will be made to the classification of genetic syndromes associated with the development of colon cancer in terms of pathogenesis, patient management and surveillance programs for specific population groups. Students will have the opportunity to discuss and evaluate the knowledge provided through the presentation and discussion of clinical cases. In the second part of the module, students will have acquired knowledge about neoadjuvant chemotherapy in colon cancer and whether it has a place in clinical practice. The clinical picture and the diagnostic algorithm for colon cancer will be fully developed, while the role of radiological imaging methods in the preoperative staging of colon cancer will have been clarified. At the end of the module, students will have acquired knowledge about the role of endoscopic resection in colon cancer and whether it has a role in clinical practice.
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