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

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

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

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
  • 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

Complications with Colorectal Surgery

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