Technical considerations in the surgical treatment of colon and rectal cancer

Abstract

Surgery is the primary mode of therapy for colorectal cancer. Advances beyond exteriorization began to appear at the end of the nineteenth century. The antibiotic era brought on more advances. Dogma abounds with respect to the technical aspects of surgery for colon and rectal cancer and few randomized, prospective trials have been done to evaluate the importance of these techniques. Firmly established are the techniques of resection of lymphatic drainage of tumors, en bloc resection of invaded structures, and obtaining at least 2 cm margins of rectal cancers. Radical lymph node dissection, luminal ligation, oophorectomy, and the "No-Touch Technique" are discussed. Despite the paucity of irrefutable scientific data to support many of the described surgical techniques, differences in outcome between surgeons suggest that technique is important. There is great need for randomized, prospective trials to evaluate the multitude of techniques described for the surgical treatment of colorectal cancer.

Circumferential sulcus-guided resection technique for improved outcomes of low-grade gliomas

“…In systemic malignancies, such as lung cancer and colon cancer, circumferential resection using no-touch technique is the standard of care. [12][13][14][15][16][17][18][19][20][21][22] Our group has recently shown that, for glioblastoma, circumferential resection of the contrast-enhancing tumor based on T1-weighted images is associated with a higher extent of resection than for PMR. 13 For diffuse LGGs, the goal of surgery is maximal safe resection of the hyperintense signal on MRI FLAIR/T2weighted sequences.…”

Circulating tumour cells and circulating nucleic acids as a measure of tumour dissemination in non-metastatic colorectal cancer surgery

“…25,26 A study in 1999 attempted to measure KRAS and p53 mutations in blood samples in 17 patients with CRC treated by conventional surgery, and 10 patients in which the no-touch technique was applied. Blood samples were obtained from the portal vein through a catheter in the right gastroepiploic vein, before, during and after surgical manipulation.…”

Die Rolle der Lymphknoten beim Kolonkarzinom

“…Sollen die intermedia Èren und zentralen Lymphknoten mitreseziert werden, ergeben sich aus diesen lymphogenen Metastasierungsmustern die folgenden radikalen Resektionsausmasse: Rechtsseitige Hemikolektomie mit Absetzen der Aa. ileocolica und colica dextra fu Èr Zo Èkum-und Aszendenskarzinome, erweiterte rechtsseitige Hemikolektomie (A. ileocolica, colica dextra und colica media) fu Èr Karzinome der rechten Flexur und des rechten Transversumanteiles, die subtotale Kolektomie (A. ileocolica, dextra, media und aszendierender Ast der A. colica sinistra) fu Èr Karzinome des linken Transversumanteils sowie der linken Flexur und eine Hemikolektomie links mit Absetzen der A. mesenterica inferior fu Èr Karzinome des Descendens und Sigmas [10]. Bei Karzinomen der rechten Flexur und des rechten Anteils des Kolon transversum sind zudem die infrapylorischen bzw.…”