Surgical Oncological Treatment of Colon Cancer
- If indicated neoadjuvant treatment
- Tumor resection including regional lymphatic drainage
- Dissection of regional blood vessels (A./V.)
- 3-Dimensional safty margins
- Mesocolic or Mesorectal Excision (CME, TME)
- Multivisceral (en bloc) resection
- Intraoperative staging
- Resection of metastases (Liver, Lung, Peritoneum)
- Exact pathological staging
- If indicated postoperative chemotherapy
K. H. Link, M. Hauser, M. Mann, P. M. Schlag: Kolonkarzinom, Chirurgische Onkologie Strategien und Standards für die Praxis
Michael Gnant, Peter M. Schlag (Hrsg.), Kapitel 23, 315-329, Springer Wien/New York, 2008
Colon cancer surgery: Laparoscopic surgery (MIC)? Yes/No!
- The original assumption, that MIC improves the long term oncological results, has not been proven. MIC may be dangerous in non expert hands! Conversion is associated with a technically related decrease in survival. Laparoscopic vs. open surgery in colon- and rectal cancer surgery is superior regarding hospital stay.
- Laparoscopic surgery offers better subjective acceptance to the patients, which may differ with age, gender, nationality.
- Only in Colon Cancer MIC is adequate to open surgery regarding long term results. MIC may be offered to patients.
Meta-Analyses: Anderson, EJSO 34, 1135-1142, 2008; Liang, EJSO 34, 1217-1224, 2008;
K. H. Link, multiple review presentations German Society of General- and Visceral Surgery etc.. ; Köckerling, 2010
Multimodal Treatment in Colon Cancer: Actual Status
- Oncologic surgery has been standardized (S3 guidelines).
- Total mesocolic excision may improve outcome.
- Adjuvant chemotherapy is standard in UICC III and should be recommeded in UICC IIA HR and IIB.
- Addition of IRI or IFNa to 5-FU+FA have not improved outcome.
- Antibody treatment has not yet improved adjuvant protocols.
- Pattern of distant metastases in colon cancer is different from rectal cancer.