Colorectal cancer surgery

Surgery remains the primary treatment while chemotherapy and/or radiotherapy may be recommended depending on the individual patient’s staging and other medical factors.

Surgeries can be categorized into curative, palliative, bypass, open-and-close, or laparoscopic 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.

• Curative surgery on rectal cancer includes total mesorectal excision (lower anterior resection) or abdominoperineal excision.^[1]

• 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^[2]

• 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.^[3]

• 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.^[4]
• Most of these cases formerly subjected to “open and close” procedures are now diagnosed in advance and surgery is avoided.

• This is a minimally-invasive technique that can reduce the size of the incision, minimize the risk of infection, and reduce post-operative pain.^[5]

• Wound infection
• Dehiscence
• Hernia
• Anastomosis breakdown, leading to abscess or fistula formation and/or peritonitis
• Bleeding with or without hematoma formation
• Adhesions leading to bowel obstruction
• Blind loop syndrome in bypass surgery
• Adjacent organ injury – most commonly to the small intestine, ureters, spleen, or bladder
• Cardiorespiratory complications such as myocardial infarction, pneumonia, arrythmia, or pulmonary embolism

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