Colon cancer: Resection standards

The surgeon is one of the most important prognostic factors for patients with colon cancer. Depending on the site of the primary tumour, the potential lymphatic spread is uni-, bi- or tridirectional. Therefore, the extent of surgical resection depends on the site of the tumour and the patient's vascular anatomy. A minimum resection of 10 cm of grossly normal bowel on both sides of the tumour is required to keep the risk of unremoved paracolic lymph node metastasis below 5%. A central ligature of main colic artery (arteries) is strongly recommended, as central lymph nodes are involved in more than 10%. The no-touch isolation technique is easily and quickly performed and has been shown to provide a survival benefit of 6% compared to the conventional technique. Adherent or infiltrated adjacent organs should never be separated from the tumour because the tumour perforation and consecutive tumour cell spillage is afflicted with a reduction in 5-year survival expectancy of up to 40 %. Prophylactic oophorectomy seems to be of no survival benefit, only infiltrated or grossly abnormal ovaries have to be removed. Sentinel lymph node biopsy facilitates an accurate nodal staging and may result in an up-staging in 15-30% and in necessitating adjuvant chemotherapy. Recently published data indicate no oncosurgical disadvantage of laparoscopic colon cancer resection compared to open technique.