Surgical treatment

Surgical removal and resection is the preferred primary method for treating colorectal cancer. Surgical treatment is indicated in virtually all patients who are diagnosed with colorectal cancer unless the prognosis of surgery is not good because the cancer is in a very advanced state or the patient suffers from another pathology. Even with the presence of metastases, palliative surgical resection of the primary tumor is indicated in most patients to prevent complications such as bleeding or eventual obstruction of the intestinal lumen.

Surgical treatment consists of wide resection of the intestinal segment involving the tumor as well as regional lymphatic drainage. There may be variations depending on the location of the primary tumor. Primary anastomosis is possible only in cases where primary preparation of the colon is performed.

Sphincter preservation rather than a definitive colostomy in patients with colorectal cancer is the goal if cancer eradication is confirmed.

Palliative treatments used in unresectable colorectal cancer are fulguration, laser photocoagulation and radiant therapy.

Radiation therapy and chemotherapy are used as adjuvant therapy to surgery in the advanced stages of the disease. Although radiation therapy has a very small role in the treatment of colon cancer, it is useful in the treatment of rectal cancer. Bulky rectal cancer can be treated preoperatively to improve the chances of resection. Radiation therapy is useful preoperatively or postoperatively as adjuvant therapy in patients with rectal cancer who are stage II (invasion of the muscle layer or rectal wall) or stage III (metastasis to regional lymph nodes). Chemotherapy in combination with radiation therapy is used adjuvant for patients with stage II or III rectal cancer.

Patients with colon cancer that extends beyond the colonic wall with or without lymph node metastases should be considered for adjuvant chemotherapy.

Complications

The postoperative complications of colorectal cancer resection are mainly infectious and related to the bacterial flora of the colon. The most frequent postoperative complication is infection of the operative wound (2 to 4% in elective surgery). This is reduced with a correct mechanical and antibiotic preparation of the colon and the prophylactic administration of antibiotics intravenously. Other risks include bleeding, pelvic abscesses, injury to neighboring organs (such as the spleen or ureter), sexual and urinary dysfunctions, and suture dehiscence.