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Primary therapy of carcinoma of the large bowel

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Abstract

Most colonic and rectal carcinomas are treated by excision, usually with the object of cure. Adequate and safe resection depends upon sound understanding of the anatomy and pathology of the tumor. The surgical options in various clinical situations are discussed but the final choice has to be individualized. Improved understanding of the biology of large bowel cancer and the advent of circular stapling devices have significantly altered the surgical practice in large bowel cancer. Despite these innovative advances, there has only been a modest improvement in survival over the last few decades. This is because the concept of “sequential tumor spread” does not always hold true. Systemic adjuvant therapy that is effective and safe is needed for selected patients. Notwithstanding, surgical resection remains the most effective therapy for large bowel cancer.

Résumé

La plupart des cancers colorectaux sont traités par l'exérèse chirurgicale à visée curative. Une résection faite dans de bonnes conditions de sécurité opératoire dépend d'une compréhension solide de l'anatomie et de la pathologie des tumeurs. Les options thérapeutiques chirurgicales dans des situations cliniques typiques sont évoquées mais en fait, chaque cas mérite d'être discuté individuellement. Une meilleure compréhension de la biologie du cancer colorectal et l'utilisation répandue des sutures mécaniques ont beaucoup modifié la chirurgie du cancer colorectal. Malgré ces progrès et innovations, la survie a très peu augmenté ces dernières décennies car, en fait, l'extension tumorale ne se fait pas toujours de “proche en proche”. Une thérapie adjuvante par voie systémique, efficace et sans majoration de risque, est nécessaire chez des patients sélectionés. Néanmoins, la résection chirurgicale reste le traitement le plus efficace en matière de cancer colorectal.

Resumen

La mayoría de los cánceres colónicos y rectales son tratadas con resección, usulamente con ánimo curativo Una resección adecuada y segura depende de un sólido conocimiento de la anatomía y de la patología del tumor. En este artículo se revisan las opciones quirúrgicas en diversas situaciones clínicas, pero la escogencia final debe ser individualizada. Un mejor conocimiento de los suturadores mecánicos circulares ha alterado en forma significativa las prácticas quirúrgicas en el cáncer del intestino grueso. A pesar de estos avances innovativos, sólo se registra una modesta mejoría en la sobrevida en comparación con los últimos decenios. Esto se debe a que el concepto de “extensión secuencial del tumor” no siempre es correcto. Una terapia sistémica adyuvante que sea efectiva y segura es necesaria para pacientes seleccionados. A pesar de todo, la resección quirúrgica sigue siendo la forma más eficaz de terapia para el cáncer del colon.

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Authors and Affiliations

  1. Department of Colorectal Surgery, The Cleveland Clinic Foundation, 9500 Euclid Avenue, 44106, Cleveland, Ohio, USA

    Victor W. Fazio MB.BS., F.R.A.C.S., F.A.C.S. & Joe J. Tjandra MB.BS., M.D., F.R.C.S. (Eng), F.R.C.P.S. (Glas), F.R.A.C.S.

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  1. Victor W. Fazio MB.BS., F.R.A.C.S., F.A.C.S.
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  2. Joe J. Tjandra MB.BS., M.D., F.R.C.S. (Eng), F.R.C.P.S. (Glas), F.R.A.C.S.
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Fazio, V.W., Tjandra, J.J. Primary therapy of carcinoma of the large bowel. World J. Surg. 15, 568–575 (1991). https://doi.org/10.1007/BF01789200

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