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Colon Cancer Surgical Treatment: Principles of Colectomy

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The ASCRS Textbook of Colon and Rectal Surgery

Abstract

Surgical resection is the primary treatment for colon cancer without distant metastases. The quality of colectomy predicts surgical and oncologic outcomes. Appropriate surgical resection entails resecting the segment of colon containing the primary tumor, the associated lymph nodes draining that segment, and en bloc resection of involved organs/tissues to achieve negative margins. Successful resection requires an intimate understanding of anatomy, surgical planes, and the colonic vasculature. This chapter will review the principals and technical aspects of oncologic resection of intraperitoneal colon cancer.

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References

  1. Available from: https://seer.cancer.gov/statfacts/html/colorect.html.

  2. Stanciu C, Trifan A, Khder SA. Accuracy of colonoscopy in localizing colonic cancer. Rev Med Chir Soc Med Nat Iasi. 2007;111(1):39–43.

    CAS  PubMed  Google Scholar 

  3. Piscatelli N, Hyman N, Osler T. Localizing colorectal cancer by colonoscopy. Arch Surg. 2005;140(10):932–5.

    PubMed  Google Scholar 

  4. Cho YB, Lee WY, Yun HR, Lee WS, Yun SH, Chun HK. Tumor localization for laparoscopic colorectal surgery. World J Surg. 2007;31(7):1491–5.

    PubMed  Google Scholar 

  5. Hilliard G, Ramming K, Thompson J Jr, Passaro E Jr. The elusive colonic malignancy. A need for definitive preoperative localization. Am Surg. 1990;56(12):742–4.

    CAS  PubMed  Google Scholar 

  6. Trakarnsanga A, Akaraviputh T. Endoscopic tattooing of colorectal lesions: is it a risk-free procedure? World J Gastrointest Endosc. 2011;3(12):256–60.

    PubMed  PubMed Central  Google Scholar 

  7. Nelson H, Petrelli N, Carlin A, Couture J, Fleshman J, Guillem J, et al. Guidelines 2000 for colon and rectal cancer surgery. J Natl Cancer Inst. 2001;93(8):583–96.

    CAS  PubMed  Google Scholar 

  8. Park SS, Park B, Park EY, Park SC, Kim MJ, Sohn DK, et al. Outcomes of high versus low ligation of the inferior mesenteric artery with lymph node dissection for distal sigmoid colon or rectal cancer. Surg Today. 2020;50(6):560–8.

    CAS  PubMed  Google Scholar 

  9. Draginov A, Chesney TR, Quereshy HA, Chadi SA, Quereshy FA. Association of high ligation versus low ligation of the inferior mesenteric artery on anastomotic leak, postoperative complications, and mortality after minimally invasive surgery for distal sigmoid and rectal cancer. Surg Endosc. 2020;34(10):4593–600.

    PubMed  Google Scholar 

  10. Olofsson F, Buchwald P, Elmstahl S, Syk I. High tie or not in resection for cancer in the sigmoid colon? Scand J Surg. 2019;108(3):227–32.

    CAS  PubMed  Google Scholar 

  11. Turnbull RB Jr, Kyle K, Watson FR, Spratt J. Cancer of the colon: the influence of the no-touch isolation technic on survival rates. Ann Surg. 1967;166(3):420–7.

    PubMed  PubMed Central  Google Scholar 

  12. Wiggers T, Jeekel J, Arends JW, Brinkhorst AP, Kluck HM, Luyk CI, et al. No-touch isolation technique in colon cancer: a controlled prospective trial. Br J Surg. 1988;75(5):409–15.

    CAS  PubMed  Google Scholar 

  13. Garcia-Olmo D, Ontanon J, Garcia-Olmo DC, Vallejo M, Cifuentes J. Experimental evidence does not support use of the “no-touch” isolation technique in colorectal cancer. Dis Colon Rectum. 1999;42(11):1449–56; discussion 54–6.

    CAS  PubMed  Google Scholar 

  14. Takii Y, Shimada Y, Moriya Y, Nakamura K, Katayama H, Kimura A, et al. A randomized controlled trial of the conventional technique versus the no-touch isolation technique for primary tumor resection in patients with colorectal cancer: Japan Clinical Oncology Group Study JCOG1006. Jpn J Clin Oncol. 2014;44(1):97–100.

    PubMed  Google Scholar 

  15. Sjo OH, Merok MA, Svindland A, Nesbakken A. Prognostic impact of lymph node harvest and lymph node ratio in patients with colon cancer. Dis Colon Rectum. 2012;55(3):307–15.

    PubMed  Google Scholar 

  16. Ogura A, Akiyoshi T, Takatsu Y, Nagata J, Nagasaki T, Konishi T, et al. The significance of extended lymphadenectomy for colorectal cancer with isolated synchronous extraregional lymph node metastasis. Asian J Surg. 2017;40(4):254–61.

    PubMed  Google Scholar 

  17. Bertelsen CA, Neuenschwander AU, Jansen JE, Tenma JR, Wilhelmsen M, Kirkegaard-Klitbo A, et al. 5-year outcome after complete mesocolic excision for right-sided colon cancer: a population-based cohort study. Lancet Oncol. 2019;20(11):1556–65.

    PubMed  Google Scholar 

  18. West NP, Hohenberger W, Weber K, Perrakis A, Finan PJ, Quirke P. Complete mesocolic excision with central vascular ligation produces an oncologically superior specimen compared with standard surgery for carcinoma of the colon. J Clin Oncol. 2010;28(2):272–8.

    PubMed  Google Scholar 

  19. Eiholm S, Ovesen H. Total mesocolic excision versus traditional resection in right-sided colon cancer - method and increased lymph node harvest. Dan Med Bull. 2010;57(12):A4224.

    PubMed  Google Scholar 

  20. Chang GJ, Rodriguez-Bigas MA, Skibber JM, Moyer VA. Lymph node evaluation and survival after curative resection of colon cancer: systematic review. J Natl Cancer Inst. 2007;99(6):433–41.

    PubMed  Google Scholar 

  21. Le Voyer TE, Sigurdson ER, Hanlon AL, Mayer RJ, Macdonald JS, Catalano PJ, et al. Colon cancer survival is associated with increasing number of lymph nodes analyzed: a secondary survey of intergroup trial INT-0089. J Clin Oncol. 2003;21(15):2912–9.

    PubMed  Google Scholar 

  22. Liang JT, Huang KC, Lai HS, Lee PH, Sun CT. Oncologic results of laparoscopic D3 lymphadenectomy for male sigmoid and upper rectal cancer with clinically positive lymph nodes. Ann Surg Oncol. 2007;14(7):1980–90.

    PubMed  Google Scholar 

  23. Liang JT, Lai HS, Huang J, Sun CT. Long-term oncologic results of laparoscopic D3 lymphadenectomy with complete mesocolic excision for right-sided colon cancer with clinically positive lymph nodes. Surg Endosc. 2015;29(8):2394–401.

    PubMed  Google Scholar 

  24. Siani LM, Lucchi A, Berti P, Garulli G. Laparoscopic complete mesocolic excision with central vascular ligation in 600 right total mesocolectomies: safety, prognostic factors and oncologic outcome. Am J Surg. 2017;214(2):222–7.

    PubMed  Google Scholar 

  25. West NP, Kobayashi H, Takahashi K, Perrakis A, Weber K, Hohenberger W, et al. Understanding optimal colonic cancer surgery: comparison of Japanese D3 resection and European complete mesocolic excision with central vascular ligation. J Clin Oncol. 2012;30(15):1763–9.

    PubMed  Google Scholar 

  26. Freund MR, Edden Y, Reissman P, Dagan A. Iatrogenic superior mesenteric vein injury: the perils of high ligation. Int J Color Dis. 2016;31(9):1649–51.

    CAS  Google Scholar 

  27. Wang C, Gao Z, Shen K, Shen Z, Jiang K, Liang B, et al. Safety, quality and effect of complete mesocolic excision vs non-complete mesocolic excision in patients with colon cancer: a systemic review and meta-analysis. Color Dis. 2017;19(11):962–72.

    CAS  Google Scholar 

  28. Storli KE, Sondenaa K, Furnes B, Eide GE. Outcome after introduction of complete mesocolic excision for colon cancer is similar for open and laparoscopic surgical treatments. Dig Surg. 2013;30(4–6):317–27.

    PubMed  Google Scholar 

  29. Gouvas N, Pechlivanides G, Zervakis N, Kafousi M, Xynos E. Complete mesocolic excision in colon cancer surgery: a comparison between open and laparoscopic approach. Color Dis. 2012;14(11):1357–64.

    CAS  Google Scholar 

  30. Feng B, Sun J, Ling TL, Lu AG, Wang ML, Chen XY, et al. Laparoscopic complete mesocolic excision (CME) with medial access for right-hemi colon cancer: feasibility and technical strategies. Surg Endosc. 2012;26(12):3669–75.

    PubMed  Google Scholar 

  31. Bertelsen CA, Larsen HM, Neuenschwander AU, Laurberg S, Kristensen B, Emmertsen KJ. Long-term functional outcome after right-sided complete mesocolic excision compared with conventional colon cancer surgery: a population-based questionnaire study. Dis Colon Rectum. 2018;61(9):1063–72.

    PubMed  Google Scholar 

  32. Lopez MJ, Monafo WW. Role of extended resection in the initial treatment of locally advanced colorectal carcinoma. Surgery. 1993;113(4):365–72.

    CAS  PubMed  Google Scholar 

  33. Curley SA, Carlson GW, Shumate CR, Wishnow KI, Ames FC. Extended resection for locally advanced colorectal carcinoma. Am J Surg. 1992;163(6):553–9.

    CAS  PubMed  Google Scholar 

  34. Zhou Z, Nimeiri HS, Benson AB 3rd. Preoperative chemotherapy for locally advanced resectable colon cancer - a new treatment paradigm in colon cancer? Ann Transl Med. 2013;1(2):11.

    PubMed  PubMed Central  Google Scholar 

  35. Dehal A, Graff-Baker AN, Vuong B, Fischer T, Klempner SJ, Chang SC, et al. Neoadjuvant chemotherapy improves survival in patients with clinical T4b colon cancer. J Gastrointest Surg. 2018;22(2):242–9.

    PubMed  Google Scholar 

  36. Bokey EL, Chapuis PH, Dent OF, Mander BJ, Bissett IP, Newland RC. Surgical technique and survival in patients having a curative resection for colon cancer. Dis Colon Rectum. 2003;46(7):860–6.

    CAS  PubMed  Google Scholar 

  37. Wakeman CJ, Dobbs BR, Frizelle FA, Bissett IP, Dennett ER, Hill AG, et al. The impact of splenectomy on outcome after resection for colorectal cancer: a multicenter, nested, paired cohort study. Dis Colon Rectum. 2008;51(2):213–7.

    CAS  PubMed  Google Scholar 

  38. Langevin JM, Rothenberger DA, Goldberg SM. Accidental splenic injury during surgical treatment of the colon and rectum. Surg Gynecol Obstet. 1984;159(2):139–44.

    CAS  PubMed  Google Scholar 

  39. Varty PP, Linehan IP, Boulos PB. Does concurrent splenectomy at colorectal cancer resection influence survival? Dis Colon Rectum. 1993;36(6):602–6.

    CAS  PubMed  Google Scholar 

  40. Yang Y, Wang G, He J, Zhang J, Xi J, Wang F. High tie versus low tie of the inferior mesenteric artery in colorectal cancer: a meta-analysis. Int J Surg. 2018;52:20–4.

    PubMed  Google Scholar 

  41. Dimitriou N, Felekouras E, Karavokyros I, Pikoulis E, Vergadis C, Nonni A, et al. High versus low ligation of inferior mesenteric vessels in rectal cancer surgery: a retrospective cohort study. J BUON. 2018;23(5):1350–61.

    PubMed  Google Scholar 

  42. Parry S, Win AK, Parry B, Macrae FA, Gurrin LC, Church JM, et al. Metachronous colorectal cancer risk for mismatch repair gene mutation carriers: the advantage of more extensive colon surgery. Gut. 2011;60(7):950–7.

    PubMed  Google Scholar 

  43. Herzig D, Hardiman K, Weiser M, You N, Paquette I, Feingold DL, et al. The American Society of Colon and Rectal Surgeons Clinical Practice Guidelines for the management of inherited polyposis syndromes. Dis Colon Rectum. 2017;60(9):881–94.

    PubMed  PubMed Central  Google Scholar 

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Correspondence to Evie H. Carchman .

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Carchman, E.H., Kalady, M.F. (2022). Colon Cancer Surgical Treatment: Principles of Colectomy. In: Steele, S.R., Hull, T.L., Hyman, N., Maykel, J.A., Read, T.E., Whitlow, C.B. (eds) The ASCRS Textbook of Colon and Rectal Surgery. Springer, Cham. https://doi.org/10.1007/978-3-030-66049-9_25

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  • DOI: https://doi.org/10.1007/978-3-030-66049-9_25

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