Surgical treatment of colorectal cancer

Abstract

Surgical treatment of colorectal cancer Abstract. For the last two decades, colorectal surgery has been evolving driven by technical innovation, new findings in clinical trials and better understanding of the pathophysiology and biology of the tumours. Efforts to improve oncological outcomes led to a centralisation of care and nowadays surgery for colorectal cancer is mainly performed in certified high-volume centres. Standardised surgical techniques have been developed in order to facilitate training and improve oncological outcome. The introduction of total mesorectal excision (TME) resulted in a better postoperative outcome, reduced local recurrence rate and better overall survival for rectal cancer. Complete mesocolic excision (CME) was described as an attempt to standardise the operative technique for colon cancer and follows the same principles of the TME in order to improve the oncological outcome. In this approach, sharp precise dissection of the embryological planes allows the maintenance of integrity of the mesocolic envelope with its lymphatic drainage. However, CME has not yet been adopted universally by surgeons and data about long-term oncological outcome are awaited. One of the most substantial recent developments in the surgery of colon cancer is the implementation of minimally invasive approach. Randomised controlled trials demonstrated comparability of laparoscopic versus open surgery for colonic cancer. However, with the recent evidence, non-inferiority of the laparoscopic approach for TME could not be proven. Obtaining a clear circumferential resection margin especially in male patients with narrow pelvis is a major issue that has a direct impact on the local recurrence of rectal cancer. In an attempt to improve quality of the TME, new surgical techniques such as transanal total mesorectal excision and robotic surgery are now widely performed. However, oncological long-term data are lacking. Preservation of function and quality of life are factors which need to be addressed when counselling the patient with rectal cancer. Organ preservation with local excision for low-risk lesions is an appropriate approach for selected patients.