Surgery for colorectal cancer. Best treatment for long-term survival. 1

Surgery for colorectal cancer. Best treatment for long-term survival. 1

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Leading expert in colorectal cancer surgery, Dr. Christoph Maurer, MD, explains how surgical technique directly impacts long-term survival. He details the critical importance of en bloc resection for tumors attached to other organs. Dr. Christoph Maurer, MD, emphasizes the need for adequate margins of healthy colon tissue. He discusses how tumor location dictates the surgical approach and lymph node removal. Proper technique prevents cancer cell spillage and improves patient outcomes.

Advanced Surgical Techniques for Colorectal Cancer Treatment and Survival

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Surgical Technique and Survival Rates

Colorectal cancer surgery is the primary treatment for achieving a cure. The technical execution of the operation is directly linked to patient survival. Dr. Christoph Maurer, MD, highlights a critical statistic: tumor spillage during surgery can reduce five-year survival expectancy by approximately 30%. This underscores why meticulous surgical technique is non-negotiable for optimal colorectal cancer treatment outcomes.

Tumor Location and Surgical Planning

The location of the primary colon cancer tumor fundamentally dictates the surgical approach. Dr. Christoph Maurer, MD, explains that tumors situated at flexures, like the splenic or hepatic flexure, present a unique challenge. These areas are where the large bowel makes a turn. Cancers in these locations can have bi-directional or even three-directional lymph node spread patterns.

This complex spread necessitates a more extensive resection to ensure all potential lymphatic drainage pathways are removed. The surgeon must be fully aware of these anatomical variations to plan a successful oncological operation.

En Bloc Resection for Adherent Tumors

A cornerstone of modern colorectal cancer surgery is the en bloc resection principle. Dr. Maurer provides a vital warning: a tumor adherent to a neighboring organ should never be separated. This adherence often indicates microscopic tumor infiltration into that organ. Attempting to separate them risks opening the tumor capsule and spilling cancer cells into the abdominal cavity, a process known as seeding.

Instead, the surgeon must perform an en bloc resection. This means removing the colon cancer tumor and the attached portion of the neighboring organ together in one single, intact specimen. This technique is essential for achieving a complete resection (R0 resection) and preventing local recurrence.

Lymph Node Removal in Colon Cancer Surgery

Adequate lymph node dissection is a critical component of curative colon cancer surgery. Lymph nodes are a primary route for cancer metastasis. The extent of lymph node removal is guided by the vascular supply to the affected colon segment. Dr. Christoph Maurer, MD, notes that along the margins of the arteries supplying the tumor, there is a potential risk for lymph node metastasis.

Removing too short a segment of the colon and its associated mesentery risks leaving behind cancerous lymph nodes. This incomplete resection compromises the curative intent of the surgery and can lead to disease recurrence.

Importance of Healthy Tissue Margins

Establishing adequate margins of healthy colon tissue is a key technical goal. Dr. Maurer provides clear guidelines for resection margins. For most colon cancers, a minimum of 10 centimeters of normal-looking colon on both sides of the primary tumor is required. This ensures any microscopic extensions of the disease are removed.

The exception to this rule is cancer at the rectosigmoid junction. In this specific location, a margin of five centimeters is considered acceptable. Dr. Anton Titov, MD, inquired about these specifics, highlighting the nuanced decision-making involved in each surgical case. Adhering to these margin guidelines is fundamental to reducing the risk of local recurrence.

Full Transcript

Dr. Anton Titov, MD: Choosing the correct surgeon for colorectal cancer surgical treatment is very important. What are the most important factors in colorectal cancer surgery? How to perform a modern surgical operation to remove a colon cancer or rectal cancer tumor? A leading Swiss abdominal cancer surgeon explains surgical treatment options for colorectal cancer and liver tumors.

Dr. Anton Titov, MD: Let's start the conversation with colon cancer. Colorectal cancer surgery remains the first and foremost treatment method for colon cancer. You published reviews on optimal selection of colorectal cancer surgery methods to improve colon cancer patients' survival. A colorectal cancer surgeon during a surgical operation often corrects staging decisions done preoperatively. The surgeon makes intraoperative observations and adjusts colon cancer staging.

How do surgery options depend on the location and extent of the colon cancer tumor? How does the surgeon help in overall colon cancer treatment decisions?

Dr. Christoph Maurer, MD: Yes, this is a very important issue. First, the colon cancer surgery method is highly dependent on the location of the primary tumor. Some colon cancer tumors are located in the splenic or hepatic flexure. This is where the large bowel makes a turn. These cancers have a bidirectional or three-directional lymph node spread. So we must be aware of this circumstance. We have to include these lymphatic nodes and lymphatic vessels into our tumor resection margins.

Sometimes a primary colorectal tumor is adherent to neighboring organs. These tumors should never be separated from the neighboring organ, because this organ may be infiltrated by a tumor. If we first separate the tumor from the neighboring organ, then we risk opening the tumor. This can spill cancer tumor cells and cause cancer seeding. Tumor seeding and tumor spillage during a surgical operation reduces the five-year survival expectancy by about 30%.

So we have to do a so-called en bloc colon cancer tumor resection. Never separate neighboring organs that adhere to a colon cancer tumor. We have to do an en bloc resection of colon cancer, including parts of the neighboring organ. So we do a complete resection en bloc.

Dr. Anton Titov, MD: How much of the normal colon do you usually take out? Do you have healthy colon margins just outside of the tumor?

Dr. Christoph Maurer, MD: It's important to have at least 10 centimeters of normal colon on both sides of the primary colon cancer tumor. A colon cancer tumor in the rectosigmoid junction is the exception. Then we have only five centimeters, this little resection margin. But otherwise, we need absolutely at least 10 centimeters of normal-looking colon when we remove a colon cancer tumor during surgery.

Because along the tumor margin of arteries, we have the potential risk to have lymph node metastasis from colon cancer. So if we take too short a segment of the colon, then we risk leaving behind lymph node metastases in the local regional area of the colon cancer tumor.