Colon Surgery

Surgery usually provides a high chance of cure in early stage colon cancer (small, low-grade tumors). The surgery aims to completely remove the primary tumor including radical removal of the adjacent lymph drainage area. An R0 resection is given if the tumor could be removed completely without any residual tumor remaining. A surgical operation with R0 resection will provide the best prognosis for the patient.

Multiple carcinomas may require a removal of the large bowel (subtotal colectomy) according to the location of the tumors.
Tumors with infiltration into adjacent compartments must be removed in a multivisceral resection with en bloc technique. This means that all diseased organs are removed en bloc.

The laparoscopic (endoscopic) surgery has become an alternative option for the treatment of colorectal cancer. The results of several big multicenter randomized studies indicate an oncologically equal outcome for both laparoscopic as well as open surgery (laparotomy). A slight advantage may be seen in the laparoscopic resection due to less pain and a shorter hospital stay. The susceptibility of laparoscopic incisions for metastatic tumor growth is very low. Randomized controlled trials show no significant differences in patients’ prognosis between open and laparoscopic surgery. Long term survival data (10 years and more) are not yet available for laparoscopic procedures.

The lymphadenectomy (resection of lymph nodes) is a surgical standard in colorectal cancer. Based on the outcome of several studies’ proving a connection between the number of resected lymph nodes and the survival of patients, the lymphadenectomy is applied as a diagnostic method for histopathological examination on the one hand, and as a therapeutic method for avoidance of local lymph node recurrence on the other hand.

A local endoscopic excision of early T1 carcinomas is justified only in exceptional cases, like e.g. in unexpected diagnostic findings after an endoscopic complete excision of a polyp in a „low risk” situation.

According to the pathological findings of the resected specimen (e.g. lymph node metastasis), chemotherapy may be given after the surgery in order to lower the risk of recurrence.