Colon Cancer Surgical Treatment

Surgical Oncological Treatment of Colon Cancer

Treatment Priciples

  • 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.
  • Individualize!