Colorectal cancer surgery
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1] Associate Editor(s)-in-Chief: Elliot B. Tapper, M.D., Saarah T. Alkhairy, M.D.
Overview
Surgery remains the primary treatment while chemotherapy and/or radiotherapy may be recommended depending on the individual patient's staging and other medical factors.
Colorectal Cancer Surgery
Surgeries can be categorized into curative, palliative, bypass, open-and-close, or laparoscopic surgical treatment.
Curative Surgical Treatment
- This surgical treatment can be offered if the tumor is localized.
- Very early cancer that develops within a polyp can often be cured by removing the polyp (i.e., polypectomy) at the time of colonoscopy.
- In colon cancer, a more advanced tumor typically requires surgical removal of the section of colon (i.e., colectomy) containing the tumor with sufficient margins, and radical en-bloc resection of mesentery and lymph nodes to reduce local recurrence.
- If possible, the remaining parts of colon are anastomosed together to create a functioning colon, otherwise a stoma is created.
- Curative surgery on rectal cancer includes total mesorectal excision (lower anterior resection) or abdominoperineal excision.[1]
Palliative Surgical Treatment
- In case of multiple metastases, a palliative resection of the primary tumor is still offered to reduce further morbidity.
- Surgical removal of isolated liver metastases is common and may be curative[2]
Bypass Surgical Treatment
- If the tumor invaded adjacent vital structures which makes excision technically difficult, surgeons may prefer to bypass the tumor (ileotransverse bypass) or to do a proximal fecal diversion through a stoma.[3]
Open-and-close Surgical Treatment
- If the surgeons find the tumor unresectable and the small bowel is involved, any more procedures would do more harm than good to the patient
- This is uncommon with laparoscopy and better radiological imaging.[4]
- Most of these cases formerly subjected to "open and close" procedures are now diagnosed in advance and surgery is avoided.
Laparoscopic-assisted Colectomy
- This is a minimally-invasive technique that can reduce the size of the incision, minimize the risk of infection, and reduce post-operative pain.[5]
Complications with Colorectal Surgery
- Wound infection
- Dehiscence
- Hernia
- Anastomosis breakdown, leading to abscess or fistula formation and/or peritonitis
- Bleeding with or without hematoma formation
- Adhesions leading to bowel obstruction
- Blind loop syndrome in bypass surgery
- Adjacent organ injury - most commonly to the small intestine, ureters, spleen, or bladder
- Cardiorespiratory complications such as myocardial infarction, pneumonia, arrythmia, or pulmonary embolism
References
- ↑ Peschaud F (2015). "[Surgical treatment of colorectal cancer]". Rev Prat. 65 (6): 779–83. PMID 26298899.
- ↑ McCullough JA, Engledow AH (2010). "Treatment options in obstructed left-sided colonic cancer". Clin Oncol (R Coll Radiol). 22 (9): 764–70. doi:10.1016/j.clon.2010.07.008. PMID 20729045.
- ↑ McGinnis LS (1994). "Surgical treatment options for colorectal cancer". Cancer. 74 (7 Suppl): 2147–50. PMID 7522123.
- ↑ Jones OM, John SK, Horseman N, Lawrance RJ, Fozard JB (2007). "Cause and place of death in patients dying with colorectal cancer". Colorectal Dis. 9 (3): 253–7. doi:10.1111/j.1463-1318.2006.01131.x. PMID 17298624.
- ↑ Zhang S, Ding Z, Qiu X, Yuan S, Yan F, Hong X; et al. (2015). "[Laparoscopic-assisted natural orifice specimen extraction radical left colectomy]". Zhonghua Wei Chang Wai Ke Za Zhi. 18 (6): 577–80. PMID 26108772.