CRC Surgery
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CRC Surgery
Colorectal
CRC Surgery
Most patients with colorectal cancer (CRC) will have surgery to remove their tumor. The procedure type and invasiveness of the procedure is dependent of the stage of the cancer and its location. Since time to surgery following diagnosis of colorectal cancer has been shown to be associated with survival, patients should undergo the appropriate procedures as soon as feasible following diagnosis.3
Localized cancers
For early-stage colon cancer (Stage 0 and sometimes with Stage 1 tumors), the cancerous polyp or area of abnormal cells can sometimes be removed using either a snare or cutting tools inserted through a colonoscope. Types of procedures include:
- Polypectomy – A polypectomy is a minimally invasive procedure where the polyp is removed at its base using a wire loop with an electrical current to cut off the polyp.
- Local excision – Local excision of the tumor is slightly more invasive than a polypectomy and involves the removal of cancer cells from the mucosa of the colon and some of the surrounding health tissue.
- Endoscopic mucosal resection– While endoscopic mucosal resection (EMR) uses a snare inserted through a colonoscope similar to a polypectomy, the procedure is more invasive since it cuts the mucosa below the polyp to ensure any possible adjacent cancerous cells are removed.
- Endoscopic submucosal dissection – Endoscopic submucosal dissection (ESD) is sometimes used if the polyps are larger or deemed to be cancerous. ESD uses an electrosurgical cutting device and removes the submucosa layer underneath the polyp. This increases the ability to ensure clear margins (removal of all of the cancerous cells in the surrounding tissue).
The decision to perform an endoscopic procedure instead of a colectomy (see below) is dependent on the depth of submucosal invasion of the cancer cells, the desired excision margin, the degree a cellular differentiation (how much different the cancer cells look from normal tissue), the amount of tumor budding, and whether cancer has encroached small lymphatic or blood (typically venous) vessels near the tumor.
A colectomy is the surgical removal of all or part of the colon where the tumor is located and adjacent lymph nodes. Typically only a section of the colon is removed with a segment of normal colon on either side of the area with the tumor also removed. This is called a hemicolectomy, partial colectomy, or segmental resection. The two sections of the colon are then reattached (anastomosis).
The amount of colon removed depends on the site of the primary lesion and the associated lymphovascular drainage. If there is only one tumor, an additional 5 to 7 cm of the colon on each side of the tumor is removed to ensure adequate margin.  The adjacent mesentery which attaches the segment of the intestines where the tumor is located to the abdominal wall is also resection to enable removal of the associated central lymph nodes.2  Adequate lymph node resection is important to enable precise staging of the disease and the determination is additional potential treatment options shoudl be considered.Â
Potential surgical options included:
- Open colectomy – the surgery is performed following an incision in the abdomen.
- Minimally invasive surgery (MIS) – MIS procedures are performed via a laparoscopic technique which includes eitehr multiport, single-port, and hand-assisted laparoscopy and robotic surgery.
The American Society of Colon and Rectal Surgeons recommends that a minimally invasive approach to elective colectomy for colon cancer is preferred when the appropriate expertise is avaiable.2  Several studies have concluded that open colectomy and MIS have equivalient outcomes with MIS procedures being assocaited with a decreased length of hospital stay and a receduced risk of complidcations compared to open surgical resection. Some patients may not be candidates for MIS procedures due to having a larger tumor or the tumor having spread to adjacent organs.Â
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Follow-up treatments
Depending on the stage of cancer and other factors, adjuvant chemotherapy and/or radiation therapy may be prescribed to reduce the risk of cancer recurrence.Â
- Kaltenmeier C, Shen C, Medich D, et al. Time to Surgery and Colon Cancer Survival in the United States. Annals of Surgery. 2021; 274 (6): 1025-1031. doi: 10.1097/SLA.0000000000003745.
- Vogel JD, Felder SI, Bhama AR, et al. The American Society of Colon and Rectal Surgeons Clinical Practice Guidelines for the Management of Colon Cancer. Dis Colon Rectum. 2022 Feb 1;65(2):148-177. doi: 10.1097/DCR.0000000000002323.
