___________________________________________________________________________ Colorectal Cancer
ASCRS GUIDELINES FOR SURGICAL MANAGEMENT OF COLON CANCER
Surgical Treatment of the Primary Tumor A thorough surgical exploration should be performed and documented.
The extent of colon resection should correspond to the lymphovascular drainage of the colon cancer site. The lymphadenectomy should be complete and en bloc with (i.e., at the same time as) the bowel segment. Clinically positive lymph nodes located outside the standard field of resection identified at the time of resection and suspected to contain metastatic disease should be biopsied or removed at the time of primary resection. Resection of involved adjacent organs should be en bloc. Synchronous colon cancers can be treated by two separate resections or subtotal colectomy. Sentinel lymph node (SLN) mapping for colon cancer does not replace standard lymphadenectomy. Laparoscopic and open colectomy achieve equivalent oncologic outcomes for localized colon cancer. The use of the laparoscopic approach should be based on the surgeon’s documented experience in laparoscopic surgery as well as on patient- and tumor-specific factors. Treatment of the malignant polyp is determined by the morphology and histology of the polyp. Prophylactic Oncologic Resection of Extraintestinal Organs Oophorectomy is advised for grossly abnormal ovaries or contiguous extension of the colon cancer, but routine prophylactic oophorectomy is not necessary Management of Synchronous Stage IV Disease Resectable stage IV disease: The treatment of patients with resectable stage IV colon cancer should be individualized based on comprehensive multidisciplinary evaluation. Unresectable stage IV disease: Palliative intervention or resection of the symptomatic primary tumor should be considered, but routine resection of the asymptomatic primary tumor is not recommended. Tumor-Related Emergencies Bleeding: Surgical resection to stop severe blood loss from localized colon cancer should follow the same oncologic principles as in elective resection. Perforation: Perforation is a life-threatening complication. After resuscitation of the patient, surgical resection to address both the perforation and the tumor should be performed, if at all possible. Obstruction: The management of patients with an obstructing cancer should be individualized but may include a definitive surgical resection with primary anastomosis. Management of Locoregional Recurrence The treatment of patients with locoregionally recurrent colon cancer should be multidisciplinary, and curative resection should adhere to the principles of primary resection Management of Peritoneal Carcinomatosis The treatment of patients with peritoneal carcinomatosis should be multidisciplinary and individualized and may include surgical cytoreduction (debulking). The role of intraperitoneal chemotherapy remains insufficiently defined. Palliative Procedures In patients with extensive incurable extent of tumor burden, palliative surgical interventions should be individualized based on the presence of symptoms. Adjuvant Therapy
Adjuvant chemotherapy may be considered for patients with high-risk stage II colon cancer. Adjuvant chemotherapy should be recommended for patients with stage III colon cancer. Source: [188]
Table 9
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MDFL2626
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