J Korean Med Assoc.  2010 Jul;53(7):569-581. 10.5124/jkma.2010.53.7.569.

Surgical Management of Colorectal Cancer

Affiliations
  • 1Department of Surgery, Seoul National University College of Medicine, Seoul, Korea. syjeong@snu.ac.kr

Abstract

In Korea, the incidence of colorectal cancer has rapidly increased in both men and women during recent two decades, and now it is the third most common cancer. Deaths related to colorectal cancer has also rapidly increased. Currently, the fourth most common cause of cancer related death is that originated from colon cancer. Over the past several years, there was a significant improvement in survival of patients who suffered from colorectal cancer and it is partly due to the introduction of newer chemotherapeutic agents such as oxaliplatin, irinotecan, bevacizumab and cetuximab, and refined radiotherapy which can be delivered preoperatively or postoperatively. However, surgery still remains the only curative modality for early stage colorectal cancer and the principal one for locally advanced colorectal cancer. The goal in surgical treatment for colorectal cancer is to maximize not only the oncologic outcome through performing wide excision of the tumor bearing area and associated lymphatics with attention to the blood supply to that segment, but also to enhance the functional outcomes including preservation of bowel, anorectal and genitourinary function. The purpose of this article is to provide an overview of standard strategies in surgical management of colorectal cancer as well as a discussion of some of the important issues pertaining to the surgery.

Keyword

Colorectal cancer; Surgery; Oncologic outcome; Functional outcome

MeSH Terms

Antibodies, Monoclonal, Humanized
Bevacizumab
Camptothecin
Cetuximab
Colonic Neoplasms
Colorectal Neoplasms
Female
Humans
Incidence
Korea
Male
Organoplatinum Compounds
Ursidae
Antibodies, Monoclonal, Humanized
Camptothecin
Organoplatinum Compounds

Reference

1. Corman ML. Corman ML, editor. Colon and rectal surgery. Colon and rectal surgery. 2005. 5th ed. New York: Lippincott Williams and Wilkins;767–903.
2. Nivatvongs S. Fazio VW, Church JM, Delaney CP, editors. Treatment of colorectal adenomas. Current therapy in colonand rectal surgery. 2004. 2nd ed. Philadelphia: Elsevier Mosby;331.
3. Hammersting R, Huppertz A, Breuer J, alzer T, lakeborough A, Carter R, Fuste LC, Heinz-Peer G, Judmaier W, Laniado M, Manfredi RM, Mathieu DG, Muller D, Mortele K, Reimer P, Reiser MF, Robinson PJ, Shamsi K, Strotzer M, Taupitz M, Tombach B, Valeri G, van Beers BE, Vogl TJ. Diagnostic efficacy of gadoxetic acid (Primovist)-enhanced MRI and spiral CT for a therapeutic strategy: comparison with intraoperative and histopathologic findings in focal liver lesions. Eur Radiol. 2008. 18:457–467.
Article
4. Moran BJ, Scholefield J.H. Scholefield JH, Abcarian H, rothey A, Maughan T, editors. MRI-directed rectal cancer surgery. Challenges in colorectal cancer. 2006. 2nd ed. Malden: Blackwell publishing.
Article
5. Nelson H, Petrelli N, Carlin A, Couture J, Fleshman J, Guillem J, Miedema B, Ota D, Sargent ID. Guidelines 2000 for colon and rectal cancer surgery. J Natl Cancer Inst. 2001. 93:583–596.
Article
6. Heald RJ, Husband EM, Ryall RD. The mesorectum in rectal cancer surgery-the clue to pelvic recurrence? Br J Surg. 1982. 69:613–616.
Article
7. Wibe A, Rendedal PR, Svensson E, Norstein J, Eide TJ, Myrvold HE, Søreide O. Prognostic significance of the circumferential resection margin following total mesorectal excision for rectal cancer. Br J Surg. 2002. 89:327–334.
Article
8. Heald RJ, Moran BJ, Ryall RD, Sexton R, MacFarlane JK. Rectal cancer: the Basingstoke experience of total mesorectal excision, 1978-1997. Arch Surg. 1998. 133:894–899.
9. Chessin DB, Guillem JG. Surgical issues in rectal cancer: a 2004 update. Clin Colorectal Cancer. 2004. 4:233–240.
Article
10. Morikawa E, Yasutomi M, Shindou K, Matsuda T, Mori N, Hida J, Kubo R, Kitaoka M, Nakamura M, Fujimoto K. Distribution of metastatic lymph nodes in colorectal cancer by the modified clearing method. Dis Colon Rectum. 1994. 37:219–223.
Article
11. Hida J, Yasutomi M, Maruyama T, Fujimoto K, Uchida T, Okuno K. Lymph node metastases detected in the mesorectum distal to carcinoma of the rectum by the clearing method: justification of total mesorectal excision. J Am Coll Surg. 1997. 184:584–588.
12. Lopez-Kostner F, Lavery IC, Hool GR, Rybicki LA, Fazio VW. Total mesorectal excision is not necessary for cancers of the upper rectum. Surgery. 1998. 124:612–617. discussion 7-8.
Article
13. Sauer R, Becker H, Hohenberger W, Rodel C, Wittekind C, Fietkau R, Martius P, Tschimelitsch J, Hager E, Hess CF, Karstens JH, Liersch T, Schmidberger H, Raab R. Preoperative versus postoperative chemoradiotherapy for rectal cancer. N Engl J Med. 2004. 351:1731–1740.
Article
14. Kapiteijn E, Marijnen CA, Nagtegaal ID, Putter H, Steup WH, Wiggers T, Rutten HJ, Pahlman L, Glimelius B, van Krieken JH, Leer JW, van de Velde CJ. Preoperative radiotherapy combined with total mesorectal excision for resectable rectal cancer. N Engl J Med. 2001. 345:638–646.
Article
15. Williams NS, Dixon MF, Johnston D. Reappraisal of the 5 centimetre rule of distal excision for carcinoma of the rectum: a study of distal intramural spread and of patients' survival. Br J Surg. 1983. 70:150–154.
Article
16. Shirouzu K, Isomoto H, Kakegawa T. Distal spread of rectal cancer and optimal distal margin of resection for sphincter-preserving surgery. Cancer. 1995. 76:388–392.
Article
17. Kwok SP, Lau WY, Leung KL, Liew CT, Li AK. Prospective analysis of the distal margin of clearance in anterior resection for rectal carcinoma. Br J Surg. 1996. 83:969–972.
Article
18. Andreola S, Leo E, Belli F, Lavarino C, Bufalino R, Tomasic G, Baldini MT, Valvo F, Navarria P, Lombardi F. Distal intramural spread in adenocarcinoma of the lower third of the rectum treated with total rectal resection and coloanal anastomosis. Dis Colon Rectum. 1997. 40:25–29.
Article
19. Pollett WG, Nicholls RJ. The relationship between the extent of distal clearance and survival and local recurrence rates after curative anterior resection for carcinoma of the rectum. Ann Surg. 1983. 198:159–163.
Article
20. Vernava AM 3rd, Moran M, Rothenberger DA, Wong WD. A prospective evaluation of distal margins in carcinoma of the rectum. Surg Gynecol Obstet. 1992. 175:333–336.
21. Moore HG, Riedel E, Minsky BD, Saltz L, Paty P, Wong D, Cohen AM, Guillem JG. Adequacy of 1-cm distal margin after restorative rectal cancer resection with sharp mesorectal excision and preoperative combined-modality therapy. Ann Surg Oncol. 2003. 10:80–85.
Article
22. Quirke P, Durdey P, Dixon MF, Williams NS. Local recurrence of rectal adenocarcinoma due to inadequate surgical resection. Histopathological study of lateral tumour spread and surgical excision. Lancet. 1986. 2:996–999.
23. Nagtegaal ID, Marijnen CA, Kranenbarg EK, van de Velde CJ, van Krieken JH. Circumferential margin involvement is still an important predictor of local recurrence in rectal carcinoma: not one millimeter but two millimeters is the limit. Am J Surg Pathol. 2002. 26:350–357.
Article
24. Marijnen CA, Nagtegaal ID, Kapiteijn E, Kranenbarg EK, Noordijk EM, van Krieken JH, van de Velde CJ, Leer JW. Radiotherapy does not compensate for positive resection margins in rectal cancer patients: report of a multicenter randomized trial. Int J Radiat Oncol Biol Phys. 2003. 55:1311–1320.
Article
25. Jeong SY, Chessin DB, Guillem JG. Surgical treatment of rectal cancer: radical resection. Surg Oncol Clin N Am. 2006. 15:95–107. vi-vii.
Article
26. Grinnell RS, Hiatt RB. Ligation of the inferior mesenteric artery at the aorta in resection for carcinoma of the sigmoid and rectum. Surg Gynecol Obstet. 1952. 92:526–534.
27. Rouffet F, Hay JM, Vacher B, Fingerhut A, Elhadad A, Flamant Y, Mathon C, Garinant A. French Association for Surgical Research. Curative resection for left colonic carcinoma: hemicolectomy vs. segmental colectomy. A prospective, controlled, multicenter trial. Dis Colon Rectum. 1994. 37:651–659.
Article
28. Turnbull RB Jr, Kyle K, Watson FR, Spratt J. Cancer of the colon: the influence of the no-touch isolation technic on survival rates. Ann Surg. 1967. 166:420–427.
Article
29. Wiggers T, Jeekel J, Arends JW, Brinkhorst AP, Kluck HM, Luyk CI, Munting JD, Povel JA, Rutten AP, Volovics A. Notouch isolation technique in colon cancer: a controlled prospective trial. Br J Surg. 1988. 75:409–415.
Article
30. Gertsch P, Baer HU, Kraft R, Maddern GJ, Altermatt HJ. Malignant cells are collected on circular staplers. Dis Colon Rectum. 1992. 35:238–241.
Article
31. Fermor B, Umpleby HC, Lever JV, Symes MO, Williamson RC. Proliferative and metastatic potential of exfoliated colorectal cancer cells. J Natl Cancer Inst. 1986. 76:347–349.
32. Mariani PP, van Pelt JF, Ectors N, Topal B, D'Hoore A, Penninckx F. Rectal washout with cytotoxic solution can be extended to the whole colon. Br J Surg. 2002. 89:1540–1544.
Article
33. Agaba EA. Does rectal washout during anterior resection prevent local tumor recurrence? Dis Colon Rectum. 2004. 47:291–296.
Article
34. Mori T, Takahashi K, Yasuno M. Radical resection with autonomic nerve preservation and lymph node dissection techniques in lower rectal cancer surgery and its results: the impact of lateral lymph node dissection. Langenbecks Arch Surg. 1998. 383:409–415.
Article
35. Hojo K, Koyama Y, Moriya Y. Lymphatic spread and its prognostic value in patients with rectal cancer. Am J Surg. 1982. 144:350–354.
Article
36. Fujita S, Yamamoto S, Akasu T, Moriya Y. Lateral pelvic lymph node dissection for advanced lower rectal cancer. Br J Surg. 2003. 90:1580–1585.
Article
37. Georgiou P, Tan E, Gouvas N, Antoniou A, Brown G, Nicholls RJ, Tekkis P. Extended lymphadenectomy versus conventional surgery for rectal cancer: a meta-analysis. Lancet Oncol. 2009. 10:1053–1062.
Article
38. Nagawa H, Muto T, Sunouchi K, Higuchi Y, Tsurita G, Watanabe T, Sawada T. Randomized, controlled trial of lateral node dissection vs. nerve-preserving resection in patients with rectal cancer after preoperative radiotherapy. Dis Colon Rectum. 2001. 44:1274–1280.
Article
39. Kim JC, Takahashi K, Yu CS, Kim HC, Kim TW, Ryu MH, Kim JH, Mori T. Comparative outcome between chemoradiotherapy and lateral pelvic lymph node dissection following total mesorectal excision in rectal cancer. Ann Surg. 2007. 246:754–762.
Article
40. Bell SW, Mourra N, Flejou JF, Parc R, Tiret E. Ex vivo sentinel lymph node mapping in colorectal cancer. Dis Colon Rectum. 2005. 48:74–79.
Article
41. Bembenek A, Rau B, Moesta T, Markwardt J, Ulmer C, Gretschel S, Schneider U, Slisow W, Schlag Pm PM. Sentinel lymph node biopsy in rectal cancer-not yet ready for routine clinical use. Surgery. 2004. 135:498–505. discussion 6-7.
Article
42. Bertagnolli M, Miedema B, Redston M, Dowell J, Niedzwiecki D, Fleshman J, Bem J, Mayer R, Zinner M, Compton C. Sentinel node staging of resectable colon cancer: results of a multicenter study. Ann Surg. 2004. 240:624–628. discussion 8-30.
43. Joosten JJ, Strobbe LJ, Wauters CA, Pruszczynski M, Wobbes T, Ruers TJ. Intraoperative lymphatic mapping and the sentinel node concept in colorectal carcinoma. Br J Surg. 1999. 86:482–486.
Article
44. Saha S, Monson KM, Bilchik A, Beutler T, Dan AG, Schochet E, Wiese D, Kaushai S, Ganatra B, Desai D. Comparative analysis of nodal upstaging between colon and rectal cancers by sentinel lymph node mapping: a prospective trial. Dis Colon Rectum. 2004. 47:1767–1772.
Article
45. Hida J, Yasutomi M, Maruyama T, Nakajima A, Uchida T, Wakano T, Tokoro T, Fujimoto K. Results from pelvic exenteration for locally advanced colorectal cancer with lymph node metastases. Dis Colon Rectum. 1998. 41:165–168.
Article
46. Lopez MJ, Monafo WW. Role of extended resection in the initial treatment of locally advanced colorectal carcinoma. Surgery. 1993. 113:365–372.
47. Orkin BA, Dozois RR, Beart RW Jr, Patterson DE, Gunderson LL, Ilstrup DM. Extended resection for locally advanced primary adenocarcinoma of the rectum. Dis Colon Rectum. 1989. 32:286–292.
Article
48. Russo P, Ravindran B, Katz J, Paty P, Guillem J, Cohen AM. Urinary diversion after total pelvic exenteration for rectal cancer. Ann Surg Oncol. 1999. 6:732–738.
Article
49. Fujisawa M, Nakamura T, Ohno M, Miyazaki J, Arakawa S, Haraguchi T, Yamanaka N, Yao A, Matsumoto O, Kuroda Y, Kamidono S. Surgical management of the urinary tract in patients with locally advanced colorectal cancer. Urology. 2002. 60:983–987.
Article
50. Moriya Y, Akasu T, Fujita S, Yamamoto S. Aggressive surgical treatment for patients with T4 rectal cancer. Colorectal Dis. 2003. 5:427–431.
Article
51. Talamonti MS, Shumate CR, Carlson GW, Curley SA. Locally advanced carcinoma of the colon and rectum involving the urinary bladder. Surg Gynecol Obstet. 1993. 177:481–487.
52. Block IR, Enquist I.F. Lymphatic studies pertaining to local spread of carcinoma of the rectum in the female. Surg Gynecol Obstet. 1961. 112:41–46.
53. Ruo L, Paty PB, Minsky BD, Wong WD, Cohen AM, Guillem JG. Results after rectal cancer resection with in-continuity partial vaginectomy and total mesorectal excision. Ann Surg Oncol. 2003. 10:664–668.
Article
54. Yamada K, Ishizawa T, Niwa K, Chuman Y, Aikou T. Pelvic exenteration and sacral resection for locally advanced primary and recurrent rectal cancer. Dis Colon Rectum. 2002. 45:1078–1084.
Article
55. Moriya Y, Akasu T, Fujita S, Yamamoto S. Total pelvic exenteration with distal sacrectomy for fixed recurrent rectal cancer in the pelvis. Dis Colon Rectum. 2004. 47:2047–2053. discussion 53-54.
Article
56. Havenga K, Enker WE, McDermott K, Cohen AM, Minsky BD, Guillem J. Male and female sexual and urinary function after total mesorectal excision with autonomic nerve preservation for carcinoma of the rectum. J Am Coll Surg. 1996. 182:495–502.
57. Mitsui T, Kobayashi S, Matsuura S, Kakizaki H, Mori T, Minami S, Koyanagi T. Vesicourethral dysfunction following radical surgery for rectal carcinoma: change in voiding pattern on sequential urodynamic studies and impact of nerve-sparing surgery. Int J Urol. 1998. 5:35–38.
Article
58. Havenga K, Enker WE. Autonomic nerve preserving total mesorectal excision. Surg Clin North Am. 2002. 82:1009–1018.
Article
59. Guillem JG, Cohen AM. Treatment options for mid- and low-rectal cancers. Adv Surg. 2000. 34:43–66.
60. Moriya Y, Sugihara K, Akasu T, Fujita S. Nerve-sparing surgery with lateral node dissection for advanced lower rectal cancer. Eur J Cancer. 1995. 31A(7-8):1229–1232.
Article
61. Hanna NN, Guillem J, Dosoretz A, Steckelman E, Minsky BD, Cohen AM. Intraoperative parasympathetic nerve stimulation with tumescence monitoring during total mesorectal excision for rectal cancer. J Am Coll Surg. 2002. 195:506–512.
Article
62. Di Betta E, D'Hoore A, Filez L, Penninckx F. Sphincter saving rectum resection is the standard procedure for low rectal cancer. Int J Colorectal Dis. 2003. 18:463–469.
Article
63. Rullier E, Laurent C, Bretagnol F, Rullier A, Vendrely V, Zerbib F. Sphincter-saving resection for all rectal carcinomas: the end of the 2-cm distal rule. Ann Surg. 2005. 241:465–469.
64. Saito N, Ono M, Sugito M, Ito M, Morihiro M, Kosugi C, Sato K, Kotaka M, Nomura S, Arai M, Kobatake T. Early results of intersphincteric resection for patients with very low rectal cancer: an active approach to avoid a permanent colostomy. Dis Colon Rectum. 2004. 47:459–466.
Article
65. Guillem JG. Ultra-low anterior resection and coloanal pouch reconstruction for carcinoma of the distal rectum. World J Surg. 1997. 21:721–727.
Article
66. Schoetz DJ Jr. Postcolectomy syndromes. World J Surg. 1991. 15:605–608.
Article
67. Lazorthes F, Fages P, Chiotasso P, Lemozy J, Bloom E. Resection of the rectum with construction of a colonic reservoir and coloanal anastomosis for carcinoma of the rectum. Br J Surg. 1986. 73:136–138.
Article
68. Furst A, Suttner S, Agha A, Beham A, Jauch KW. Colonic Jpouch vs. coloplasty following resection of distal rectal cancer: early results of a prospective, randomized, pilot study. Dis Colon Rectum. 2003. 46:1161–1166.
69. Laurent A, Parc Y, McNamara D, Parc R, Tiret E. Colonic J-Pouch-Anal Anastomosis for Rectal Cancer: A Prospective, Randomized Study Comparing Handsewn vs. Stapled Anastomosis. Dis Colon Rectum. 2005. 2.
Article
70. Lazorthes F, Gamagami R, Chiotasso P, Istvan G, Muhammad S. Prospective, randomized study comparing clinical results between small and large colonic J-pouch following coloanal anastomosis. Dis Colon Rectum. 1997. 40:1409–1413.
Article
71. Z'Graggen K, Maurer CA, Buchler MW. Transverse coloplasty pouch. A novel neorectal reservoir. Dig Surg. 1999. 16:363–366.
72. Ho YH, Brown S, Heah SM, Tsang C, Seow-Choen F, Eu KW, Tang CL. Comparison of J-pouch and coloplasty pouch for low rectal cancers: a randomized, controlled trial investigating functional results and comparative anastomotic leak rates. Ann Surg. 2002. 236:49–55.
73. Ballantyne GH, Quin J. Surgical treatment of liver metastases in patients with colorectal cancer. Cancer. 1993. 71:12 Suppl. 4252–4266.
Article
74. Stangl R, Altendorf-Hofmann A, Charnley RM, Scheele J. Factors influencing the natural history of colorectal liver metastases. Lancet. 1994. 343:1405–1410.
Article
75. Ohlsson B, Stenram U, Tranberg KG. Resection of colorectal liver metastases: 25-year experience. World J Surg. 1998. 22:268–276. discussion 76-77.
Article
76. Minagawa M, Makuuchi M, Torzilli G, Takayama T, Kawasaki S, Kosuge T, Yamamoto J, Imamura H. Extension of the frontiers of surgical indications in the treatment of liver metastases from colorectal cancer: long-term results. Ann Surg. 2000. 231:487–499.
Article
77. Bozzetti F, Doci R, Bignami P, Morabito A, Gennari L. Patterns of failure following surgical resection of colorectal cancer liver metastases: rationale for a multimodal approach. Recent Results Cancer Res. 1988. 110:164–167.
Article
78. Doci R, Gennari L, Bignami P, Montalto F, Morabito A, Bozzetti F. One hundred patients with hepatic metastases from colorectal cancer treated by resection: analysis of prognostic determinants. Br J Surg. 1991. 78:797–801.
Article
79. Pedersen IK, Burcharth F, Roikjaer O, Baden H. Resection of liver metastases from colorectal cancer. Indications and results. Dis Colon Rectum. 1994. 37:1078–1082.
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