What is the plan for resection in a patient with colon cancer involving 50% of the wall circumference and multiple linear deep ulcerations on colonoscopy?

From the Guidelines

The recommended approach for a colon cancer patient with 50% circumferential wall involvement and multiple linear deep ulcerations on colonoscopy is option D: Resection of both primary tumor and secondary lesions. This comprehensive surgical approach is necessary because the presence of deep ulcerations suggests an aggressive tumor that may have already spread beyond the primary site. The surgical plan should include a formal oncologic resection of the primary tumor with adequate margins (typically 5-10 cm), along with removal of the regional lymph node basin and any visible secondary lesions. This approach allows for both therapeutic intervention and proper pathological staging. The extent of resection would typically involve removing the affected segment of colon along with its mesentery containing the lymphatic drainage. Following surgery, the patient should receive appropriate adjuvant therapy based on the final pathological staging. This aggressive approach is justified because partial circumferential involvement with ulcerations indicates a locally advanced tumor that requires definitive treatment to achieve the best oncological outcome and prevent complications such as obstruction, perforation, or bleeding. According to the guidelines from the World Journal of Emergency Surgery 1, the surgical options for complicated colorectal cancer depend primarily on the location of the tumor, comorbidities of the patient, and degree of their clinical status derangement at presentation. For left-sided lesions, Hartmann’s procedure should be considered the procedure of choice, especially in unstable patients 1. However, in the context of a patient with 50% circumferential wall involvement and multiple linear deep ulcerations, a more comprehensive approach is necessary to ensure optimal oncological outcomes. The guidelines from the Annals of Oncology 1 support the use of a wide resection of the involved segment of bowel, along with the removal of its lymphatic drainage, to achieve the best oncological outcome. Therefore, option D: Resection of both primary tumor and secondary lesions is the most appropriate approach for this patient, as it allows for both therapeutic intervention and proper pathological staging, and is supported by the most recent and highest quality evidence 1.

From the Research

Plan for Resection

The plan for resection in a cancer colon patient with 50% of wall circumference involvement and multiple linear deep ulcerations, as shown by colonoscopy, can be considered based on the following points:

• The primary treatment approach for such cases often involves resection of the primary tumor, potentially followed by treatment of any metastases found 2.
• Studies have shown that primary tumor resection (PTR) can be associated with longer survival in patients with metastatic colon cancer and unresectable synchronous metastases 2.
• The decision for resection and the approach used can depend on various factors including the tumor's location, size, and the patient's overall health condition 3, 4.
• Different anastomosis methods, such as overlap anastomosis and functional end-to-end anastomosis (FEEA), have been compared in terms of clinical efficacy in laparoscopic radical resection of colorectal cancer, with overlap anastomosis showing potential benefits in terms of operation time and recovery 5.

Considerations for Resection

Key considerations for the plan of resection include:

• The extent of tumor involvement and the presence of any metastases 6, 2.
• The patient's suitability for surgery, including their overall health and any comorbidities 3.
• The potential risks and benefits of different surgical approaches, including the risk of anastomotic leakage and other complications 4, 5.
• The potential for adjuvant therapies, such as chemotherapy or targeted therapy, which may be considered based on the tumor's molecular characteristics and the patient's overall condition 6.

Options for Resection

Given the information provided, the options for resection can be considered as follows:

• Resection of the primary tumor, potentially followed by treatment of any metastases found (Option A or D) 2.
• The choice between these options would depend on the specific details of the patient's case, including the extent of tumor involvement, the presence of any metastases, and the patient's overall health condition.