Strategia actuală şi direcţii viitoare în chirurgia cancerului de colon. Review al literaturii

Abstract

Introduction. We chose colon cancer as a subject of our study because, beyond the screening efforts and of a minimally invasive precision surgery, supported by the latest generation oncology therapies, adapted to ge­ne­tic analysis and the calculation of the individual risk of patients, we are still confronting with a low survival prog­no­sis, which correlates with lymph node status. Un­like rec­tal cancer, to which the surgical treatment has moved to the secondary plane, surgery remains the saving the­ra­­peu­­tic solution for colon cancer. Several recent studies ana­ly­zing neoadjuvant immunotherapy are ongoing but re­quire further evaluations to demonstrate the long-term be­nefit. Materials and methods. We performed a li­te­ra­ture search in the PubMed database from the last five years using the words of interest, as follows: current affairs, co­lon cancer, surgical treatment, transanal, extensive lym­pha­de­nec­tomy, sentinel lymph node. In addition, pa­pers from the reference bibliography were consulted. Re­sults. The main topics of scientific debate individualized in recent years converge towards a personalized surgery to optimize co­lo­nic resection and radicality by extending lym­ph­ade­nec­to­my, by intraoperative evaluation of colon vascularization, as well as by lymphatic drainage mapping and guiding colon resections according to local anatomical peculiarities. Our search generated 402 titles, of which 89 in the last year. Subsequently, those that did not have the abstract avai­la­ble or were not written in English were excluded. Dis­cus­sion. Recent studies have observed that the efforts to detect micrometastases, as well as the extensive excision of the regional ganglia confered a more precise pathological ana­to­my staging and improved the oncological prognosis of the patient. Conclusions. Current technologies, both in terms of diagnosis and treatment, allow us to perform an ex­ten­si­ve radical surgery with minimal risks in the short and long term.