Surgical approach to colon cancer

Surgical approach to colon cancer

Surgical approach to colon cancerColon cancer is the third most commonly diagnosed cancer in the US in both men and women, and it’s also the third leading cause of cancer deaths, overall. Recent estimates from the American Cancer Society indicated that approximately 140,000 patients were diagnosed with colon cancer in 2011 and approximately 49,000 died from the disease.

The majority of these cancer diagnosis and deaths can be prevented by early screening tests such as Fecal Occult Blood Test, Stool DNA Test and Colonoscopy. This approach has been successful, because most of these cancers develop from colon polyps, which are benign growths of the inner lining of the colonic mucosa. Even though most polyps will not become cancer, detecting and removing them can prevent cancer from occurring.

Thanks to the significantly increased adoption of these tests over the past years, an unprecedented decrease in colon cancer incidence and death rates has been reported. Unfortunately, only about half of people aged 50 or older still have been following recommended screening guidelines.

Overall prognosis and risk of recurrence depends on the stage of the cancer, which indicates how deep into the colon wall the cancer extends and whether cancer cells have spread to nearby lymph nodes or to distant organs, most commonly the liver or lungs. The more advanced and the more aggressive the tumor, the higher the chances of recurrence and death. In those cases, chemotherapy can significantly decrease mortality rates and increase survival rates.

Despite the increased effectiveness of chemotherapy protocols, the most effective approach to colon cancer treatment remains surgical resection, unless it has spread to distal organs. In that case, the cancer is defined as metastatic and is incurable even though chemotherapy protocols have made great advances in prolonging the survival of these patients.

Surgery consists of removing the segment of the colon containing the cancer along with the lymph nodes related to that specific segment. The two most important prognostic factors of a good operation are the presence of clean surgical margins of resection, indicating that the cancer has been completely removed, and negative lymph nodes, which indicates that cancer cells have not started to spread outside of the mass and into the blood stream. When tumor cells are noted at the surgical margins during pathologic analysis, prognosis becomes very poor and even chemotherapy might not be effective enough to prevent local recurrence and progression of the cancer. On the other hand, if the margins are clear but the lymph nodes appear affected by cancer, chemotherapy can significantly increase the chances of survival.

Multiple surgical techniques have been developed over the past several years. The traditional “open” surgery consists of exposing the abdominal cavity through a large midline incision, while the more recent minimally invasive procedures (such as laparoscopic, laparoscopic hand-assisted and robotic surgery) adopt the use of small incisions to insert a camera and small instruments into a CO2-filled abdominal cavity in order to perform the resection.

The results and the effectiveness of these two approaches are similar as long as the margins of resection and the obtained lymph nodes are negative. It has been proven, time and time again, that minimally invasive techniques can significantly  expedite the patient’s recovery from surgery because of reduced postoperative pain, faster recovery of bowel function, decreased hospital stay and decreased risk of postoperative wound issues such as wound infection and hernias.

The less invasive procedures are slightly shorter in duration and lower in cost as these patients are usually discharged from the hospital much earlier than those that have undergone open procedures.

The feasibility of minimally invasive surgery depends on whether the patient is a good candidate for the procedure and whether that particular surgeon is experienced in minimally invasive surgery.