Surgical treatment of colon cancer

Treatment of colonic carcinoma consists of wide surgical resection of the involved section and its regional lymphatic drainage after preparation of the bowel (1).

• blood supply and distribution of regional lymph nodes influence the extent of colonic resection, but usually at least 5 cm on either side of the tumour is resected (1)
• palliative resection of the primary tumour is carried out (if considered resectable), even if distant metastases have occurred, since prevention of obstruction or bleeding may offer palliation for long periods (2,3).

The abdomen is explored to determine resectability of the tumour and to search for multiple primary carcinomas of the colon, distant metastases, and associated abdominal disease. Care is taken not to contribute to the spread of the tumour by unnecessary palpation. Some authors have even advocated occlusion of the bowel with encircling tape on either side of the lesion in order to contain exfoliated cancer cells within the segment to be resected.
The cancer-bearing portion is mobilised and removed.

Laparoscopic (including laparoscopically assisted) resection is recommended as an alternative to open resection for individuals with colorectal cancer in whom both laparoscopic and open surgery are considered suitable (3).

Reference:

• (1) Labianca R et al. Primary colon cancer: ESMO Clinical Practice Guidelines for diagnosis, adjuvant treatment and follow-up. Ann Oncol. 2010;21 Suppl 5:v70-7.
• (2) National Comprehensive Cancer Network (NCCN) 2012. NCCN clinical Practice Guidelines on Oncology. Colon Cancer
• (3) National Institute for Health and Clinical Excellence (NICE) 2014. Colorectal cancer: the diagnosis and management of colorectal cancer