Surgical Management of Colorectal Cancer
Article information
J Korean Med Assoc. 2010;53(7):569-581
Publication date (electronic) : 2010 July 06
doi :
https://doi.org/10.5124/jkma.2010.53.7.569
Received 2010 May 27; Accepted 2010 June 10.
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.
Keywords: Colorectal cancer; Surgery; Oncologic outcome; Functional outcome
References
1. Corman ML. In : Corman ML, ed. Colon and rectal surgery. Colon and rectal surgery 2005. 5th edth ed. New York: Lippincott Williams and Wilkins; 767–903.
2. Nivatvongs S. In : Fazio VW, Church JM, Delaney CP, eds. Treatment of colorectal adenomas. Current therapy in colonand rectal surgery 2004. 2nd edth 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. 18457–467.
4. Moran BJ, Scholefield J.H. In : Scholefield JH, Abcarian H, rothey A, Maughan T, eds. MRI-directed rectal cancer surgery. Challenges in colorectal cancer 2006. 2nd edth ed. Malden: Blackwell publishing;
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. 93583–596.
6. Heald RJ, Husband EM, Ryall RD. The mesorectum in rectal cancer surgery-the clue to pelvic recurrence? Br J Surg 1982. 69613–616.
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. 89327–334.
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. 133894–899.
9. Chessin DB, Guillem JG. Surgical issues in rectal cancer: a 2004 update. Clin Colorectal Cancer 2004. 4233–240.
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. 37219–223.
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. 184584–588.
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. 124612–617.
discussion 7-8.
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. 3511731–1740.
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. 345638–646.
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. 70150–154.
16. Shirouzu K, Isomoto H, Kakegawa T. Distal spread of rectal cancer and optimal distal margin of resection for sphincter-preserving surgery. Cancer 1995. 76388–392.
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. 83969–972.
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. 4025–29.
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. 198159–163.
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. 175333–336.
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. 1080–85.
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. 2996–999.
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. 26350–357.
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. 551311–1320.
25. Jeong SY, Chessin DB, Guillem JG. Surgical treatment of rectal cancer: radical resection. Surg Oncol Clin N Am 2006. 1595–107.
vi-vii.
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. 92526–534.
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. 37651–659.
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. 166420–427.
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. 75409–415.
30. Gertsch P, Baer HU, Kraft R, Maddern GJ, Altermatt HJ. Malignant cells are collected on circular staplers. Dis Colon Rectum 1992. 35238–241.
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. 76347–349.
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. 891540–1544.
33. Agaba EA. Does rectal washout during anterior resection prevent local tumor recurrence? Dis Colon Rectum 2004. 47291–296.
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. 383409–415.
35. Hojo K, Koyama Y, Moriya Y. Lymphatic spread and its prognostic value in patients with rectal cancer. Am J Surg 1982. 144350–354.
36. Fujita S, Yamamoto S, Akasu T, Moriya Y. Lateral pelvic lymph node dissection for advanced lower rectal cancer. Br J Surg 2003. 901580–1585.
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. 101053–1062.
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. 441274–1280.
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. 246754–762.
40. Bell SW, Mourra N, Flejou JF, Parc R, Tiret E. Ex vivo sentinel lymph node mapping in colorectal cancer. Dis Colon Rectum 2005. 4874–79.
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. 135498–505.
discussion 6-7.
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. 240624–628.
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. 86482–486.
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. 471767–1772.
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. 41165–168.
46. Lopez MJ, Monafo WW. Role of extended resection in the initial treatment of locally advanced colorectal carcinoma. Surgery 1993. 113365–372.
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. 32286–292.
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. 6732–738.
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. 60983–987.
50. Moriya Y, Akasu T, Fujita S, Yamamoto S. Aggressive surgical treatment for patients with T4 rectal cancer. Colorectal Dis 2003. 5427–431.
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. 177481–487.
52. Block IR, Enquist I.F. Lymphatic studies pertaining to local spread of carcinoma of the rectum in the female. Surg Gynecol Obstet 1961. 11241–46.
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. 10664–668.
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. 451078–1084.
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. 472047–2053.
discussion 53-54.
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. 182495–502.
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. 535–38.
58. Havenga K, Enker WE. Autonomic nerve preserving total mesorectal excision. Surg Clin North Am 2002. 821009–1018.
59. Guillem JG, Cohen AM. Treatment options for mid- and low-rectal cancers. Adv Surg 2000. 3443–66.
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.
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. 195506–512.
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. 18463–469.
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. 241465–469.
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. 47459–466.
65. Guillem JG. Ultra-low anterior resection and coloanal pouch reconstruction for carcinoma of the distal rectum. World J Surg 1997. 21721–727.
66. Schoetz DJ Jr. Postcolectomy syndromes. World J Surg 1991. 15605–608.
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. 73136–138.
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. 461161–1166.
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.
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. 401409–1413.
71. Z'Graggen K, Maurer CA, Buchler MW. Transverse coloplasty pouch. A novel neorectal reservoir. Dig Surg 1999. 16363–366.
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. 23649–55.
73. Ballantyne GH, Quin J. Surgical treatment of liver metastases in patients with colorectal cancer. Cancer 1993. 7112 Suppl. 4252–4266.
74. Stangl R, Altendorf-Hofmann A, Charnley RM, Scheele J. Factors influencing the natural history of colorectal liver metastases. Lancet 1994. 3431405–1410.
75. Ohlsson B, Stenram U, Tranberg KG. Resection of colorectal liver metastases: 25-year experience. World J Surg 1998. 22268–276.
discussion 76-77.
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. 231487–499.
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. 110164–167.
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. 78797–801.
79. Pedersen IK, Burcharth F, Roikjaer O, Baden H. Resection of liver metastases from colorectal cancer. Indications and results. Dis Colon Rectum 1994. 371078–1082.
Article information Continued
Copyright © 2010 Korean Medical Association