Surgical management of locally advanced and locally recurrent colon cancer

Abstract

Locally advanced and locally recurrent colon cancers pose a surgical challenge with tumors extending into surrounding structures and organs. Anticipation of the need for an extended surgical resection, often with multivisceral en bloc organ removal, is critical for surgical planning. For both primary and recurrent tumors, postsurgical long-term survival is achievable but only after complete resection. The role of neoadjuvant and adjuvant therapy continues to be redefined in this era of biologic chemotherapeutics, and multimodality therapy holds promise in aiding resection and improving postsalvage survival.

Keywords: Locally advanced; colon cancer; locoregional; recurrent; salvage; surgery.

Figures

Figure 1

(A) Computed tomography scan of a 52-year-old patient with a hepatic flexure (HF) colon adenocarcinoma adjacent to the duodenum (D). The patient underwent right colectomy and en bloc partial duodenectomy. (B) A photomicrograph of the lesion (H&E stain, ×20) demonstrating moderately differentiated colonic adenocarcinoma (CRC) invading into the muscularis propria (Mp) of the duodenum. Sm, small bowel submucosa; Br, Brunner’s glands; M, mucosa.

Figure 2

(A) Computed tomography scan of a 62-year-old patient with a splenic flexure (SF) colon adenocarcinoma invading the tail of the pancreas (P) and into the abdominal wall. The patient underwent left hemicolectomy with en bloc resection of the pancreatic tail, spleen, abdominal wall, and portion of the left hemidiaphragm. (B) A photomicrograph of the lesion (H&E stain, ×20) revealing moderately differentiated colonic adenocarcinoma (CRC) invading into the pancreas (P). IC, Islet cells of Langerhans surrounded by pancreatic acinar cells.

Figure 3

Kaplan-Meier survival curves divided by resection type. The 5-year disease-specific survival for patients who underwent a curative R0 resection, incomplete R1 and R2 resection, or no disease resection was 58%, 5%, and 0%, respectively (p < 0.0001).