Arild Nesbakken1, Maria Gaard. 1. Gastrokirurgisk avdeling, Aker universitetssykehus, 0514 Oslo. arild.nesbakken@aker-sykehus.no
Abstract
BACKGROUND: The incidence of colon cancer is increasing in Norway and about 2200 new cases are now diagnosed each year. This paper presents accepted principles of the surgical treatment of the disease. MATERIAL AND METHODS: The article is based on literature retrieved from the PubMed and Cochrane databases, guidelines from other European countries and USA, and the authors' clinical experience. RESULTS AND INTERPRETATION: Some 2 / 3 of the patients have no distant metastases and a resectable primary tumour, and the intention of treatment is curative. A curative resection is achieved by applying the following techniques: The lymphovascular pedicle is divided centrally, removing all the draining regional lymph nodes of the tumour-bearing bowel segment. The circumferential dissection is carried out in the mesocolic plane. In cases of tumour infiltration of this plane or infiltration of neighbouring organs, extended circumferential resection is necessary to obtain free margins. A minimum bowel resection margin of 5 cm on either side of the tumour is oncologically adequate, but the extent of bowel resection depends on the individual's vessel anatomy and bowel circulation. A multidisciplinary team should treat patients with potentially resectable distant metastases. Multimodal treatment is an option and treatment should follow a certain sequence. With ileus due to obstructing cancer of the transverse and left colon, endoluminal stenting should be attempted as a bridge to surgery within 1 - 2 weeks. The quality of surgical treatment of colorectal cancer could be improved in Norway, by categorizing surgical techniques more systematically and ensuring more consistent reporting to the new Norwegian colorectal cancer register.
BACKGROUND: The incidence of colon cancer is increasing in Norway and about 2200 new cases are now diagnosed each year. This paper presents accepted principles of the surgical treatment of the disease. MATERIAL AND METHODS: The article is based on literature retrieved from the PubMed and Cochrane databases, guidelines from other European countries and USA, and the authors' clinical experience. RESULTS AND INTERPRETATION: Some 2 / 3 of the patients have no distant metastases and a resectable primary tumour, and the intention of treatment is curative. A curative resection is achieved by applying the following techniques: The lymphovascular pedicle is divided centrally, removing all the draining regional lymph nodes of the tumour-bearing bowel segment. The circumferential dissection is carried out in the mesocolic plane. In cases of tumour infiltration of this plane or infiltration of neighbouring organs, extended circumferential resection is necessary to obtain free margins. A minimum bowel resection margin of 5 cm on either side of the tumour is oncologically adequate, but the extent of bowel resection depends on the individual's vessel anatomy and bowel circulation. A multidisciplinary team should treat patients with potentially resectable distant metastases. Multimodal treatment is an option and treatment should follow a certain sequence. With ileus due to obstructing cancer of the transverse and left colon, endoluminal stenting should be attempted as a bridge to surgery within 1 - 2 weeks. The quality of surgical treatment of colorectal cancer could be improved in Norway, by categorizing surgical techniques more systematically and ensuring more consistent reporting to the new Norwegian colorectal cancer register.