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Colon Cancer Surgery

Surgery remains the mainstay of treatment not only because it is the only way ofeffectively removing the tumor but also because it permits staging of the disease by

sampling of the lymph nodes around the colon. This is the reason why the standard

operations are done including a margin of colon and blood vessels extending beyond thetumor itself. Based on the anatomy of the colon we divided it in three major segments:

the right colon, the transverse colon and the left colon. The right side of the colon extends

from the cecum in the right lower quadrant of the abdomen to the hepatic flexure which islocated in the right upper quadrant (below the rib cage). The transverse colon takes a

horizontal direction across the upper abdomen into the left upper quadrant abutting the

spleen, hence the name of splenic flexure. The left colon begins at the splenic flexure

and ends at the inlet of the pelvis where the rectum begins. The sigmoid colon is part ofthe left colon at its lower aspect in the left lower quadrant of the abdomen.

Tumors anywhere in the right side are treated with a right colectomy which involves

removing the cecum and its connection to the small bowel (ileocecal valve), the

ascending colon and the hepatic flexure along with the ileocolic vessels and at least theright colic artery. In tumors of the transverse colon the right colectomy is extended to the

splenic flexure including another set of blood vessels called the middle colic vessels.

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Tumors any where in the left side are treated with a left colectomy which extends from

the splenic flexure to the rectum along with the inferior mesenteric vessels.

As long as the bowel has been well prepared before surgery the goal is to reconnect bothends. If the colon was obstructed precluding a good preparation, then a colostomy or

ileostomy may be necessary. Right colectomies are performed with the patient lying

supine on the operating table, meaning with the legs down. Left colectomies require toelevate the legs during surgery in lithotomy position to access the anus and rectum for the

reconnection of colon to rectum.

The specimen of colon and blood vessels removed at surgery is submitted to pathologyfor microscopic examination. This examination is most accurate when done over a

period of 3 to 4 days. The pathologist will generate the staging of the tumor (hyperlink to

patient conditions/colorectal cancer/staging).

Both right and left colectomies are can be done either through the traditional open

approach or laparoscopically. I chose to use a hand port up and down the navel for

extraction of the specimen.

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