The Surveillance, Epidemiology, and End
Results (SEER) Program of the National Cancer Institute reports
that in the United States, more than 90,000 people are diagnosed with colon
cancer and more than 35,000 were diagnosed with rectal cancer each year. SEER estimates that approximately 50,000 die of
colon or rectal cancer every year. Although cancer surgery has been of
great benefit to patients with large bowel cancer, a hidden flaw
that has caused the death of countless patients has gone
unrecognized. Although the surgeon has dealt successfully with
the primary tumor, he has neglected to treat microscopic
residual disease. Persistent cancer cells
within the abdomen and pelvis are responsible for the death of
30-50% of the patients who die with this disease and are
responsible for tragic quality of life consequences that result
from intestinal obstruction caused by cancer recurrence at the
resection site and on peritoneal surfaces.
Optimal surgical techniques for large bowel cancer resection minimize the residual microscopic disease that may result from surgical trauma. New concepts regarding exposure, hemostasis, adequate lymphadenectomy and lateral margins of excisions have occurred. Clinical data shows that a 30 - 50% improvement in survival is possible with an optimization of surgical technique.
Not only should the surgical event for primary colon and rectal cancer be optimized, but also the successful management of peritoneal carcinomatosis should be initiated in the operating room. Resection site disease and peritoneal carcinomatosis can be prevented through the use of perioperative intraperitoneal chemotherapy in patients at high risk of microscopic residual disease. These are patients with peritoneal seeding, perforated cancer, positive peritoneal cytology, ovarian involvement, tumor spill during surgery and adjacent organ involvement.
Peritoneal dissemination can be prevented, at least in part, by proper surgical technique utilized to resect the primary colon or rectal cancer. Established peritoneal carcinomatosis can be cured with proper combinations of peritonectomy procedures, visceral resections and perioperative intraperitoneal chemotherapy. With a combination of proper techniques for the resection of primary disease, peritonectomy procedures for the removal of all visible peritoneal implants, intraoperative and early postoperative chemotherapy for the eradication of microscopic residual disease, and quantitative tools for proper patient selection, one can optimize the surgical treatment of patients with colon and rectal cancer.
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