Surgical Treatment:
Pre operative preparation:
• Mechanical preparation,
•
In colonic cancer there is good evidence that there is no benefit of
pre operative preparation .While rectal cancer suggest mechanical
bowel preparation is still appropriate
.
• The antiembolic stocking ,prophylactic subcutaneous low
molecular weight heparin .
• *single dose of proper antiembiotic to reduce wound infection
and sepsis .
• *In all cases where stoma seem most likely
careful pre operative counseling
• Operations:
• Designed to remove the primary tumour and
draining locoregional lymph nodes .
• Right hemicolectomy for right sided cancer .
• Extended right hemicolectomy for ca of transverse colon and
splenic flexure ,to remove in addition the whole transverse colon
and splenic flexure .
• Left hemicolectomy ,for descending colon and sigmoid cancers.
• Laparoscopic surgery for colonic cancer nowadays
• Emergency surgery:
• In UK 20% of colonic cancer patients presents as emergency,the
majority with obstruction .
• In right sided cancer ,usually possible to do primary anastomoses
during the operation of right hemicolectomy .while if there is
perforation and the patient is unstable ,advisable to bring out an
ileo/ colostomy rather than anastamosing bowel .
• Left sided cancer,resection and anastamosis,with proximal
colostomy if leaking is a possibility.But if facilities are present,an
obstructing left sided lesion can be treated with an expanding
metal stent.This has the advantage of converting an emergency
operation with high chance of stoma to situation which can be
managed semi electively with a resection and anastamosis.
• PROGNOSIS:
• Five year survival 50%.
• Patients with Duke 's A ===>90% have disease free five years .(
disease confined to the bowel wall.)
• Spread of the disease out side the bowel wall reduces five year
survival to60%.
• Patients with lymph nodes metastasis five year survival 30%.
Colorectal cancer follow up
• Surveillance colonoscopy to detect synchronous and
metachronous bowel tumours
• US,CT scan for liver metastasis
• CEA ( carcinoembryonic antigen