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Utskriftsdato (20.11.2017)

Surgery for locally advanced colon cancer


Medical editor Stein G. Larsen MD
Gastroenterological Surgeon
Oslo University Hospital
Norway

General

Locally advanced colon cancer grows into surrounding organs. Which organs that are involved depends on the location of the cancer. Due to its mobility, sigmoid colon cancer often grows into the pelvic organs. This can also occur when the cecum is mobile and in rare cases in a very long transverse colon.

When there is infiltration into essential structures such as veins, nerves, and bone of the posterior abdominal wall, it may be appropriate to administer pre- or postoperative radiation. The advantage of postoperative radiation is that the area with highest risk of recurrence is identified and can be marked with clips during surgery to reduce the radiation field as much as possible.

The condition is often combined with peritoneal carcinomatosis which will be a contraindication to extensive surgery.

A palliative resection may be appropriate if the condition clearly influences quality of life.

Indication

  • Colon cancer (locally advanced/local relapse)

Goals

  • Curation
  • Palliation
  • Improve/ prevent extensive reduction of life quality

Equipment

  • Laparotomy tray
  • Bookwalter's self-retaining retractor
  • Stapling instruments: cross stapling/closing-deviding/circular

Preparation

  • The patient must be informed that the resection will not be performed if distant metastases can be verified in the abdomen during the procedure.
  • Preoperative bowel emptying is not done as this does not reduce the frequency of anastomsis leakage or infection.
  • Thrombosis prophylaxis
  • Antibiotic prophylaxis 
  • Epidural catheter is inserted for postoperative pain treatment for 1-3 days.
  • The patient lies in the supine position on the operating table.
  • The operation is carried out under general anasthesia.

Implementation

  • A mid-line incision curving to the right of the navel is usually made.
  • The tumor with the adherent organs are removed en-bloc.
  • The abdomen is washed with a cytotoxic solution if there is a possibility for peritoneal tumor growth, or there has been peroperative spillage of bowel content.
  • The abdomen is closed.
  • A drain is installed only if there is increased risk of anastomosis leakage or bleeding.

Follow-up

  • The patient may be mobilized as early as possible.
  • The patient may start to eat and drink on the first postoperative day.
  • Bladder catheter is removed on the first postoperative day or when the patient is mobilized.
  • The drain is removed when there is no longer fresh blood, usually after 2-3 days.
  • The epidural catheter is removed usually after 2-3 days and the patient is given oral analgesic.
  • The time of discharge depends on what type of resection is performed and possible complications.

Complications from surgery 

Early

  • Cardiopulmonary complications depend on the patient general health status, operation length and extensiveness.
  • In a colon resection, postoperative mortality is 0-2%.
  • Leakage from the bladder/urether can occur.
  • Anastomosis leakage can occur.

Delayed

  • Ventral hernias in the abdominal wound can occur
  • Postoperative ileus can occur.  
  • Functional handicaps depend on which organs are resected.