Modern concepts in cancer of the colon and rectum



Measures to control both local recurrence and distant vascular spread have been analyzed in depth under 8 major categories. The control of vascular spread is advocated by early distant ligation of the vascular trunks and in right hemicolectomy by starting the dissection in the gastro-colic area rather than to the right of the ascending colon; the latter should minimize the possibility of dissemination of cancer cells into the systemic circulation. Local spread can be minimized by isolating the tumor segment from the wound and abdomen. Essentials of this technique, which should be a standard part of colon surgery include isolation of the malignant tumor segment, wide excision of the mesentery, irrigation of each lumen of the bowel with distilled water or half strength Dakin's solution, and excision of each end of the bowel crushed by the crushing clamps before beginning the anastomosis. Current concepts of the role of cancer detection, polypoid lesions and other factors influencing prognosis also have been reviewed.