J.Jpn. Surg. Soc.. 104(5): 422-426, 2003

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Feature topic

ACTUAL STANDARDS AND CONTROVERSIES IN COLORECTAL CANCER SURGERY

In early colorectal cancer, the standard treatment for superficial carcinoma limited to the mucosa is endoscopic polypectomy or local resection. If the carcinoma invades the submucosa the standard surgical procedure is bowel resection with lymph node dissection. In advanced colon cancer, the ideal extent of bowel resection is defined by removing the blood supply and lymphatics at the level of the origin of the primary feeding arterial vessels. When the primary tumor is equidistant from two feeding vessels, both vessels should be excised at the origin. It is desirable to remove is more than 10 cm of the bowel on either side of the primary tumor. The value of no-touch isolation is controversial. Laparoscopic-assisted colectomy should be limited to clinical trials. For patients with advanced rectal cancer, 4-6 cm clearmargins from the attached mesorectum distal to the tumor are desirable. The ideal distal margin length is 3 cm or greater from the transected mucosal edge to the distal edge of the primary tumor. The inferior mesenteric artery should be excised at its origin. Extended lateral lymph node dissection is indicated for patients with lower rectal cancer invading the muscularis propria or deeper. In stage IV and recurrent cancer, surgical resection is recommended if it appears to offer cure.

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