Improving oncologic outcomes for colorectal cancer at high risk for local-regional recurrence with novel surgical techniques.

Despite innovation in surgical technology, colorectal adenocarcinoma is a disease process with a risk of local and regional progression of disease. This article seeks to identify patients with primary disease who are at high risk for minimal residual disease from cancer spread after resection. These are the patients who will profit from novel perioperative surgical treatments that will improve the clearance and containment of cancer cells disseminated prior to or at the time of the adenocarcinoma resection. Clinical factors that identify these patients at high risk for local recurrence and peritoneal metastases are presented. Data regarding novel surgical techniques that include perioperative cancer chemotherapy to provide more optimal treatment are described. The perioperative timing of the revised surgical options is emphasized.