Colorectal cancer surgery: Difference between revisions
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{{Colon cancer}} | {{Colon cancer}} | ||
''' | To view the surgery of familial adenomatous polyposis (FAP), click [[Familial adenomatous polyposis surgery|'''here''']]<br> | ||
To view the surgery of hereditary nonpolyposis colorectal cancer (HNPCC), click [[Hereditary nonpolyposis colorectal cancer surgery|'''here''']]<br><br> | |||
{{CMG}} {{AE}} Elliot B. Tapper, M.D., Saarah T. Alkhairy, M.D. | |||
==Overview== | ==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. | Surgery remains the primary treatment while chemotherapy and/or radiotherapy may be recommended depending on the individual patient's staging and other medical factors. | ||
==Surgery== | ==Colorectal Cancer Surgery== | ||
Surgeries can be | Surgeries can be categorized into curative, palliative, bypass, open-and-close, or laparoscopic surgical treatment. | ||
===Curative Surgical Treatment=== | |||
* Very early cancer that develops within a [[polyp]] can often be cured by removing the polyp (i.e., polypectomy) at the time of [[colonoscopy]]. | *This surgical treatment can be offered if the tumor is localized. | ||
* In colon cancer, a more advanced tumor typically requires surgical removal of the section of colon containing the tumor with sufficient margins, and radical en-bloc resection of [[mesentery]] and [[lymph node]]s to reduce local recurrence | *Very early cancer that develops within a [[polyp]] can often be cured by removing the polyp (i.e., polypectomy) at the time of [[colonoscopy]]. | ||
* Curative surgery on rectal cancer includes [[total mesorectal excision]] ([[lower anterior resection]]) or [[abdominoperineal excision]]. | *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 node]]s to reduce local recurrence. | ||
:*If possible, the remaining parts of colon are [[anastomosis|anastomosed]] together to create a functioning colon, otherwise a [[stoma (medicine)|stoma]] is created. | |||
*Curative surgery on rectal cancer includes [[total mesorectal excision]] ([[lower anterior resection]]) or [[abdominoperineal excision]].<ref name="pmid26298899">{{cite journal| author=Peschaud F| title=[Surgical treatment of colorectal cancer]. | journal=Rev Prat | year= 2015 | volume= 65 | issue= 6 | pages= 779-83 | pmid=26298899 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=26298899 }}</ref> | |||
In case of multiple metastases, | ===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<ref name="pmid20729045">{{cite journal| author=McCullough JA, Engledow AH| title=Treatment options in obstructed left-sided colonic cancer. | journal=Clin Oncol (R Coll Radiol) | year= 2010 | volume= 22 | issue= 9 | pages= 764-70 | pmid=20729045 | doi=10.1016/j.clon.2010.07.008 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=20729045 }}</ref> | |||
If the tumor invaded | ===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 (medicine)|stoma]].<ref name="pmid7522123">{{cite journal| author=McGinnis LS| title=Surgical treatment options for colorectal cancer. | journal=Cancer | year= 1994 | volume= 74 | issue= 7 Suppl | pages= 2147-50 | pmid=7522123 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=7522123 }}</ref> | |||
===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.<ref name="pmid17298624">{{cite journal| author=Jones OM, John SK, Horseman N, Lawrance RJ, Fozard JB| title=Cause and place of death in patients dying with colorectal cancer. | journal=Colorectal Dis | year= 2007 | volume= 9 | issue= 3 | pages= 253-7 | pmid=17298624 | doi=10.1111/j.1463-1318.2006.01131.x | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=17298624 }}</ref> | |||
*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 procedure|minimally-invasive]] technique that can reduce the size of the incision, minimize the risk of infection, and reduce post-operative pain.<ref name="pmid26108772">{{cite journal| author=Zhang S, Ding Z, Qiu X, Yuan S, Yan F, Hong X et al.| title=[Laparoscopic-assisted natural orifice specimen extraction radical left colectomy]. | journal=Zhonghua Wei Chang Wai Ke Za Zhi | year= 2015 | volume= 18 | issue= 6 | pages= 577-80 | pmid=26108772 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=26108772 }}</ref> | |||
[[ | ==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 | ||
* [[Adhesion (medicine)| | *[[Adhesion (medicine)|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]], [[pulmonary embolism]] | *[[Cardiorespiratory arrest|Cardiorespiratory]] complications such as [[myocardial infarction]], [[pneumonia]], [[arrythmia]], or [[pulmonary embolism]] | ||
==References== | ==References== | ||
{{Reflist|2}} | {{Reflist|2}} | ||
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Latest revision as of 01:10, 28 January 2019
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To view the surgery of familial adenomatous polyposis (FAP), click here
To view the surgery of hereditary nonpolyposis colorectal cancer (HNPCC), click here
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.