Surgery for colorectal cancer: When to perform?

Article written by MSc Vu Van Quan - Gastroenterologist - Department of General Surgery & Anesthesia - Vinmec Hai Phong International General Hospital.

The colon and rectum are part of the large intestine, located at the end of the digestive tract that connects with the small intestine. Based on anatomical structure, colon and rectum are divided into:
ascending colon Transverse colon Descending colon Sigma colon (pelvis colon) Rectal Or can be divided into:
On the right side: ascending colon and right half of transverse colon On the left side: Left half of transverse colon, descending colon, and sigmoid colon (pelvis) Rectal

2.1. Why surgery to remove the colon - rectum? Surgery is the most important treatment in cancer, especially in its early stages. Radical surgery can completely remove the tumor when there are no signs of invasion or metastasis.
If radical treatment is not possible, surgery still removes most of the malignant cells, reduces the compression caused by the tumor, increases the survival time and improves the quality of life for the patient.
2.2. In what situations is surgery used to treat colon cancer? Indications for surgery to remove the colon and rectum:
For colorectal cancer, surgery is almost mandatory at every stage.
Indications for radical (or radical), temporary, extensive, and clean surgery depend on the following factors:
a) Radical or radical surgery
This is extensive resection of the tumor according to its origin. Cancer obstruction: remove the segment of intestine bearing the tumor to ensure the safe border of the two ends of the cut intestine, remove all regional mesenteric lymph nodes and cut off the root of the feeding blood vessels. Surgery is indicated for:
Patients in good condition. The cancer is in a stage that has not metastasized far (A, B, C according to Dukes ranking or stage 0, I, II, III according to TNM). The cancer is still localized in the intestinal wall and has not invaded surrounding organs or has invaded but is still resectable.

b) Extensive surgery
This is a radical, extensive resection that combines resection of invasive adjacent organs and partial or complete resection of metastatic organs.
The patient's condition allows for a major surgery. Cancer that invades nearby organs or metastasizes but is also resectable. c) Surgical cleaning
Resection of the colon and rectum with tumors with the aim of cleaning to avoid complications of infection, bowel obstruction, tumor rupture or in cases of metastasis that cannot be removed completely. .
d) Temporary surgery
Usually the following methods are performed:
Shorten the upper bowel to the lower bowel of the tumor. On-line colostomy: bringing the bowel before the tumor out of the abdomen to make an ostomy. Indicated for the following cases:
Late stage of cancer, unable to undergo radical surgery: stage D (Dukes) or stage IV (according to TNM), patient's condition is too poor to tolerate surgery. big.
Contraindications:
The tumor is too large, the cancer has metastasized far, into the adjacent organs, to the peritoneum that cannot be resected. Patients who are elderly and weak or have severe comorbidities that cannot be operated on (eg, heart failure, respiratory failure)

In the treatment of colorectal cancer to increase the effectiveness of treatment, in addition to surgery, in each case, it is possible to consider a combination of adjuvant therapy (chemotherapy, radiation therapy, ...).
3.1 Chemotherapy Chemotherapy or chemotherapy is a method of using cytotoxic drugs to destroy malignant cells in the body of cancer patients. Besides local and regional treatments such as surgery and radiation therapy, systemic treatment including chemotherapy has become an important weapon.
Chemotherapy is increasingly developed and effective thanks to constant efforts in finding and inventing new drugs with new mechanisms that have a stronger effect on killing cancer cells while being toxic to cancer cells. body is minimized.
It is possible to combine chemotherapy with targeted therapy.
3.2. Radiation therapy Radiation therapy is a cancer treatment that uses high-energy ionizing radiation to destroy cancer cells.
Usually applied to metastatic lesions (metastasis of liver, lung, bone, brain, ...), symptomatic radiotherapy.

At the Department of Gastroenterology of Vinmec Hai Phong International Hospital, laparoscopic colectomy combined with lymph node dissection is one of the key technical categories.
Although it has only been implemented since January 2019, but up to now, the number of successful laparoscopic right colectomy surgery has been higher than 95%, the average hospital stay is only about 4 -5 days.
Medical standard equipment is the technical highlight of Vinmec Hai Phong, namely:
Full HD laparoscopic surgery system Karl Storz GmbH Laparoscope Ligasure REFVLF 10GEN, knife ultrasound, ... Besides, a well-trained professional team is always the strength of personnel at Vinmec International General Hospital system. Laparoscopic colonectomy at Vinmec Hai Phong is performed by Master, Doctor Vu Van Quan - who specializes in examining and treating surgical diseases of the gastrointestinal tract, including colon and diseases of the gastrointestinal tract. abdominal peritoneum, abdominal wall. With his extensive practical experience, the doctor has directly conducted many successful endoscopic gastrointestinal surgeries in general and right colectomy in particular.
In addition, for the surgery to be safe and successful, it is impossible not to mention the team of anesthesiologists and anesthesiologists of Vinmec Hai Phong. With a very good level of anesthesia, anesthesia and postoperative analgesia, the leader in applying the world's leading anesthetic-anesthesia methods also significantly contributes to patient safety during surgery and quick recovery. after surgery.
If you need advice and support on laparoscopic colorectal surgery at Vinmec Hai Phong, please contact HOTLINE 0225 7309 888.
If you need consultation and examination at other Vinmec hospitals in the system Healthcare nationwide, please make an appointment on the website to be served.