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 would be 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 invaded through multiple layers of the colon wall. The surgical resection should include the primary tumor with adequate margins (typically 5-10 cm on either side), along with the regional lymph nodes and any visible secondary lesions. This approach allows for both therapeutic intervention and proper pathological staging. The surgery would typically involve a segmental colectomy with primary anastomosis, though the exact procedure depends on tumor location. Following resection, pathological examination will determine the need for adjuvant therapy based on factors such as tumor stage, lymph node involvement, and margin status. This aggressive surgical approach is justified because incomplete resection could lead to early recurrence, continued bleeding, potential obstruction, and compromised long-term survival outcomes. According to the guidelines 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 this case, since the patient has 50% circumferential wall involvement and multiple linear deep ulcerations, a more comprehensive approach is necessary to ensure complete resection of the tumor and any potential secondary lesions.

Some key points to consider in the management of this patient include:

• The importance of preoperative staging, including CT scan and colonoscopy, to determine the extent of the tumor and any potential secondary lesions 1
• The need for a multidisciplinary approach, including surgery, oncology, and radiology, to ensure optimal management of the patient 1
• The potential for complications, such as anastomotic leak, and the need for careful postoperative monitoring and management 1
• The importance of considering the patient's overall health and comorbidities when determining the best surgical approach 1

Overall, the goal of treatment should be to achieve complete resection of the tumor, while minimizing morbidity and mortality, and optimizing quality of life. According to the guidelines 1, a comprehensive surgical approach, including resection of both primary and secondary lesions, is the most appropriate management strategy for this patient.

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, stage, 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 metastases 6, 2.
• The patient's suitability for surgery, including factors such as age, overall health, and the presence of any comorbidities 3.
• The potential benefits and risks of different surgical approaches, including the risk of anastomotic leakage and other complications 4, 5.
• The role of systemic therapy, such as chemotherapy, in the treatment plan, especially for patients with metastatic disease 6, 2.

Surgical Approach

The choice of surgical approach, including the decision to perform a primary resection with or without anastomosis, or to create an ostomy, depends on various factors, including:

• The location and extent of the tumor 4.
• The patient's overall condition and suitability for major surgery 3.
• The potential for complications, such as anastomotic leakage, and how these might be managed 4, 5.