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Surgical management of colorectal cancer: A review of the literature

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Abstract

Background

Colon cancer management continues to evolve with significant advances in chemotherapy, surgical technique and palliative interventions. As the options of therapy have improved, so have the challenges of management of primary colon cancer.

Review

A review of historical and up to date literature was undertaken utilising Medline/PubMed to examine relevant topics of interest-related to the surgical management. Enhanced knowledge of genetics associated with colon cancer has improved our care of patients with hereditary colon cancer syndromes. Additionally, traditional approaches to surgical intervention for primary colon cancer have been questioned and will be discussed in this review including the role of laparoscopy, use of mechanical bowel preparation, management of the primary tumour in the face of metastatic disease, as well as the role of palliative intervention in select patients.

Conclusion

Colon cancer has seen improvement and expansion of therapeutic approaches to primary colon cancer. Laparoscopy and palliative interventions have become widely accepted with level I evidence to demonstrate good patient outcomes. Traditional dogma with mechanical bowel preparation has been challenged and debunked with regards to the efficacious benefits previously accepted. The management of the primary tumour has now become increasingly complex as it appears to be a reasonable approach to manage the primary tumour non-operatively in select cases of extracolonic disease requiring management.

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References

  1. Jemal A, Siegel R, Ward E, Hao Y, Xu J, Thun MJ (2009) Cancer statistics, 2009. CA Cancer J Clin 59:225–249

    Article  PubMed  Google Scholar 

  2. Guillem JG, Smith AJ, Calle JP, Ruo L (1999) Gastrointestinal polyposis syndromes. Curr Probl Surg 36:217–323

    Article  CAS  PubMed  Google Scholar 

  3. Giardiello FM, Hamilton SR, Krush AJ, Piantadosi S, Hylind LM, Celano P, Booker SV, Robinson CR, Offerhaus GJ (1993) Treatment of colonic and rectal adenomas with sulindac in familial adenomatous polyposis. N Engl J Med 328: 1313–1316

    Article  CAS  PubMed  Google Scholar 

  4. Lynch HT, de la Chapelle A (2003) Hereditary colorectal cancer. N Engl J Med 348:919–932

    Article  CAS  PubMed  Google Scholar 

  5. Debinski HS, Love S, Spigelman AD, Phillips RK (1996) Colorectal polyp counts and cancer risk in familial adenomatous polyposis. Gastroenterology 110:1028–1030

    Article  CAS  PubMed  Google Scholar 

  6. Church J, Simmang C (2003) Practice parameters for the treatment of patients with dominantly inherited colorectal cancer (familial adenomatous polyposis and hereditary nonpolyposis colorectal cancer). Dis Colon Rectum 46:1001–1012

    Article  PubMed  Google Scholar 

  7. Bertario L, Russo A, Radice P, Varesco L, Eboli M, Spinelli P, Reyna A, Sala P (2000) Genotype and phenotype factors as determinants for rectal stump cancer in patients with familial adenomatous polyposis. Hereditary Colorectal Tumors Registry. Ann Surg 231:538–543

    Article  CAS  PubMed  Google Scholar 

  8. Vasen HF, Watson P, Mecklin JP, Lynch HT (1999) New clinical criteria for hereditary nonpolyposis colorectal cancer (HNPCC, Lynch syndrome) proposed by the International Collaborative group on HNPCC. Gastroenterology 116:1453–1456

    Article  CAS  PubMed  Google Scholar 

  9. Vasen HF, Mecklin JP, Khan PM, Lynch HT (1991) The International Collaborative Group on Hereditary Non-Polyposis Colorectal Cancer (ICG-HNPCC). Dis Colon Rectum 34:424–425

    Article  CAS  PubMed  Google Scholar 

  10. Aarnio M, Mecklin JP, Aaltonen LA, Nystrom-Lahti M, Jarvinen HJ (1995) Life-time risk of different cancers in hereditary non-polyposis colorectal cancer (HNPCC) syndrome. Int J Cancer 64:430–433

    Article  CAS  PubMed  Google Scholar 

  11. Lynch HT, Riley BD, Weissman SM, Coronel SM, Kinarsky Y, Lynch JF, Shaw TG, Rubinstein WS (2004) Hereditary nonpolyposis colorectal carcinoma (HNPCC) and HNPCClike families: Problems in diagnosis, surveillance, and management. Cancer 100:53–64

    Article  PubMed  Google Scholar 

  12. Lynch HT (1996) Is there a role for prophylactic subtotal colectomy among hereditary nonpolyposis colorectal cancer germline mutation carriers? Dis Colon Rectum 39:109–110

    Article  CAS  PubMed  Google Scholar 

  13. Nichols RL, Broido P, Condon RE, Gorbach SL, Nyhus LM (1973) Effect of preoperative neomycin-erythromycin intestinal preparation on the incidence of infectious complications following colon surgery. Ann Surg 178:453–462

    Article  CAS  PubMed  Google Scholar 

  14. Slim K, Vicaut E, Panis Y, Chipponi J (2004) Meta-analysis of randomised clinical trials of colorectal surgery with or without mechanical bowel preparation. Br J Surg 91: 1125–1130

    Article  CAS  PubMed  Google Scholar 

  15. Slim K, Vicaut E, Launay-Savary MV, Contant C, Chipponi J (2009) Updated systematic review and meta-analysis of randomised clinical trials on the role of mechanical bowel preparation before colorectal surgery. Ann Surg 249:203–209

    Article  PubMed  Google Scholar 

  16. Campisi P, Badhwar V, Morin S, Trudel JL (1999) Postoperative hypocalcemic tetany caused by fleet phosphosoda preparation in a patient taking alendronate sodium: report of a case. Dis Colon Rectum 42:1499–1501

    Article  CAS  PubMed  Google Scholar 

  17. Bergeron E, Ouellette D, Dube S, Beauchamp G (1997) Bowel preparation with polyethylene glycol electrolyte lavage solution is potentially hazardous in patients with carcinoma of the cardia: a case report. Can J Surg 40:456–458

    CAS  PubMed  Google Scholar 

  18. Schelling JR (2000) Fatal hypermagnesemia. Clin Nephrol 53:61–65

    CAS  PubMed  Google Scholar 

  19. The clinical outcomes of surgical therapy study group (2004) A comparison of laparoscopically assisted and open colectomy for colon cancer. N Engl J Med 350:2050–2059

    Article  Google Scholar 

  20. Buunen M, Veldkamp R, Hop WC, Kuhry E, Jeekel J, Haglind E, Pahlman L, Cuesta MA, Msika S, Morino M, Lacy A, Bonjer HJ (2009) Survival after laparoscopic surgery versus open surgery for colon cancer: long-term outcome of a randomised clinical trial. Lancet Oncol 10:44–52

    Article  PubMed  Google Scholar 

  21. Guillou PJ, Quirke P, Thorpe H, Walker J, Jayne DG, Smith AM, Heath RM, Brown JM (2005) Short-term endpoints of conventional versus laparoscopic-assisted surgery in patients with colorectal cancer (MRC CLASICC trial): multicentre, randomised controlled trial. Lancet 365:1718–1726

    Article  PubMed  Google Scholar 

  22. Konyalian VR, Rosing DK, Haukoos JS, Dixon MR, Sinow R, Bhaheetharan S, Stamos MJ, Kumar RR (2007) The role of primary tumour resection in patients with stage IV colorectal cancer. Colorectal Dis 9:430–437

    Article  CAS  PubMed  Google Scholar 

  23. Cook AD, Single R, McCahill LE (2005) Surgical resection of primary tumors in patients who present with stage IV colorectal cancer: an analysis of surveillance, epidemiology, and end results data, 1988 to 2000. Ann Surg Oncol 12: 637–645

    Article  PubMed  Google Scholar 

  24. Damjanov N, Weiss J, Haller DG (2009) Resection of the primary colorectal cancer is not necessary in nonobstructed patients with metastatic disease. Oncologist 14:963–969

    Article  PubMed  Google Scholar 

  25. Scoggins CR, Meszoely IM, Blanke CD, Beauchamp RD, Leach SD (1999) Nonoperative management of primary colorectal cancer in patients with stage IV disease. Ann Surg Oncol 6:651–657

    Article  CAS  PubMed  Google Scholar 

  26. Mentha G, Majno PE, Andres A, Rubbia-Brandt L, Morel P, Roth AD (2006) Neoadjuvant chemotherapy and resection of advanced synchronous liver metastases before treatment of the colorectal primary. Br J Surg 93:872–878

    Article  CAS  PubMed  Google Scholar 

  27. Poultsides GA, Servais EL, Saltz LB, Patil S, Kemeny NE, Guillem JG, Weiser M, Temple LK, Wong WD, Paty PB (2009) Outcome of primary tumor in patients with synchronous stage IV colorectal cancer receiving combination chemotherapy without surgery as initial treatment. J Clin Oncol 27: 3379–3384

    Article  PubMed  Google Scholar 

  28. Verhoef C, van der Pool AE, Nuyttens JJ, Planting AS, Eggermont AM, de Wilt JH (2009) The “liver-first approach” for patients with locally advanced rectal cancer and synchronous liver metastases. Dis Colon Rectum 52:23–30

    PubMed  Google Scholar 

  29. Fong Y, Fortner J, Sun RL, Brennan MF, Blumgart LH (1999) Clinical score for predicting recurrence after hepatic resection for metastatic colorectal cancer: analysis of 1001 consecutive cases. Ann Surg 230:309–318; discussion 318–321

    Article  CAS  PubMed  Google Scholar 

  30. Ohman U (1982) Prognosis in patients with obstructing colorectal carcinoma. Am J Surg 143:742–747

    Article  CAS  PubMed  Google Scholar 

  31. Dohmoto M (1991) New method — Endoscopic implantation of rectal stent in palliative treatment of malignant stenosis. Endosc Digest 3:1507–1512

    Google Scholar 

  32. Tilney HS, Lovegrove RE, Purkayastha S, Sains PS, Weston-Petrides GK, Darzi AW, Tekkis PP, Heriot AG (2007) Comparison of colonic stenting and open surgery for malignant large bowel obstruction. Surg Endosc 21:225–233

    Article  CAS  PubMed  Google Scholar 

  33. Khot UP, Lang AW, Murali K, Parker MC (2002) Systematic review of the efficacy and safety of colorectal stents. Br J Surg 89:1096–1102

    Article  CAS  PubMed  Google Scholar 

  34. Saida Y, Sumiyama Y, Nagao J, Uramatsu M (2003) Longterm prognosis of preoperative “bridge to surgery” expandable metallic stent insertion for obstructive colorectal cancer: comparison with emergency operation. Dis Colon Rectum 46:S44–4

    PubMed  Google Scholar 

  35. Osman H (2000) The cost effectiveness of self-expanding metal stents in the management of malignant left-sided large bowel obstruction. Colorectal Dis 2:233–237

    Article  Google Scholar 

  36. Karoui M, Charachon A, Delbaldo C, Loriau J, Laurent A, Sobhani I, Tran Van Nhieu J, Delchier JC, Fagniez PL, Piedbois P, Cherqui D (2007) Stents for palliation of obstructive metastatic colon cancer: impact on management and chemotherapy administration. Arch Surg 142:619–623; discussion 623

    Article  PubMed  Google Scholar 

  37. Scheithauer W, Rosen H, Kornek GV, Sebesta C, Depisch D (1993) Randomised comparison of combination chemotherapy plus supportive care with supportive care alone in patients with metastatic colorectal cancer. BMJ 306:752–755

    Article  CAS  PubMed  Google Scholar 

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Correspondence to Mark Bloomston.

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Chokshi, R.J., Abdel-Misih, S. & Bloomston, M. Surgical management of colorectal cancer: A review of the literature. Indian J Surg 71, 350–355 (2009). https://doi.org/10.1007/s12262-009-0093-5

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  • DOI: https://doi.org/10.1007/s12262-009-0093-5

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