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Surgical resection of primary colon cancer

Miguel A Rodriguez-Bigas, MD
Section Editor
Martin Weiser, MD
Deputy Editor
Wenliang Chen, MD, PhD


The majority of primary cancers arising in the colon are adenocarcinomas. A surgical resection is the only curative treatment modality for localized colon cancer. The goal of surgical resection of primary colon cancer is complete removal of the tumor, the major vascular pedicles, and the lymphatic drainage basin of the affected colonic segment. En bloc resection of contiguous structures is indicated if there is attachment or infiltration of the tumor into a potentially resectable organ or structure. Patients with symptoms of complicated disease (eg, obstruction, perforation) may require a staged approach to resection.

Surgical resection may also be indicated in selected patients with limited potentially resectable metastatic disease in the liver and/or lung. (See "Management of potentially resectable colorectal cancer liver metastases" and "Surgical resection of pulmonary metastases: Benefits, indications, preoperative evaluation, and techniques".)

The surgical management of the primary in patients with localized colon cancer is reviewed here. The epidemiology, clinical presentation, staging, and medical therapies used to treat colon cancer (eg, chemotherapy, radiation therapy), surgical treatment of metastatic disease, issues surrounding resection of the primary site in patients who present with metastatic disease, and prognosis following treatment of localized colon cancer are reviewed separately:

(See "Colorectal cancer: Epidemiology, risk factors, and protective factors".)

(See "Clinical presentation, diagnosis, and staging of colorectal cancer".)

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Literature review current through: Nov 2017. | This topic last updated: Mar 14, 2017.
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  1. Bonjer HJ, Hop WC, Nelson H, et al. Laparoscopically assisted vs open colectomy for colon cancer: a meta-analysis. Arch Surg 2007; 142:298.
  2. Jackson TD, Kaplan GG, Arena G, et al. Laparoscopic versus open resection for colorectal cancer: a metaanalysis of oncologic outcomes. J Am Coll Surg 2007; 204:439.
  3. Kuhry E, Schwenk WF, Gaupset R, et al. Long-term results of laparoscopic colorectal cancer resection. Cochrane Database Syst Rev 2008; :CD003432.
  4. Lacy AM, Delgado S, Castells A, et al. The long-term results of a randomized clinical trial of laparoscopy-assisted versus open surgery for colon cancer. Ann Surg 2008; 248:1.
  5. Clinical Outcomes of Surgical Therapy Study Group, Nelson H, Sargent DJ, et al. A comparison of laparoscopically assisted and open colectomy for colon cancer. N Engl J Med 2004; 350:2050.
  6. Fleshman J, Sargent DJ, Green E, et al. Laparoscopic colectomy for cancer is not inferior to open surgery based on 5-year data from the COST Study Group trial. Ann Surg 2007; 246:655.
  7. Colon Cancer Laparoscopic or Open Resection Study Group, Buunen M, Veldkamp R, et al. Survival after laparoscopic surgery versus open surgery for colon cancer: long-term outcome of a randomised clinical trial. Lancet Oncol 2009; 10:44.
  8. Liang JT, Huang KC, Lai HS, et al. Oncologic results of laparoscopic versus conventional open surgery for stage II or III left-sided colon cancers: a randomized controlled trial. Ann Surg Oncol 2007; 14:109.
  9. Leung KL, Kwok SP, Lam SC, et al. Laparoscopic resection of rectosigmoid carcinoma: prospective randomised trial. Lancet 2004; 363:1187.
  10. Jayne DG, Thorpe HC, Copeland J, et al. Five-year follow-up of the Medical Research Council CLASICC trial of laparoscopically assisted versus open surgery for colorectal cancer. Br J Surg 2010; 97:1638.
  11. Jayne DG, Guillou PJ, Thorpe H, et al. Randomized trial of laparoscopic-assisted resection of colorectal carcinoma: 3-year results of the UK MRC CLASICC Trial Group. J Clin Oncol 2007; 25:3061.
  12. Zheng Z, Jemal A, Lin CC, et al. Comparative effectiveness of laparoscopy vs open colectomy among nonmetastatic colon cancer patients: an analysis using the National Cancer Data Base. J Natl Cancer Inst 2015; 107.
  13. Nelson H, Petrelli N, Carlin A, et al. Guidelines 2000 for colon and rectal cancer surgery. J Natl Cancer Inst 2001; 93:583.
  14. Amri R, Bordeianou LG, Sylla P, Berger DL. Association of Radial Margin Positivity With Colon Cancer. JAMA Surg 2015; 150:890.
  15. AJCC (American Joint Committee on Cancer) Cancer Staging Manual, 7th edition, Edge, SB, Byrd, DR, Compton, CC, et al (Eds) (Eds), Springer, New York 2010. p.143.
  16. Kitano S, Inomata M, Mizusawa J, et al. Survival outcomes following laparoscopic versus open D3 dissection for stage II or III colon cancer (JCOG0404): a phase 3, randomised controlled trial. Lancet Gastroenterol Hepatol 2017; 2:261.
  17. Chang GJ, Rodriguez-Bigas MA, Skibber JM, Moyer VA. Lymph node evaluation and survival after curative resection of colon cancer: systematic review. J Natl Cancer Inst 2007; 99:433.
  18. Compton CC, Fielding LP, Burgart LJ, et al. Prognostic factors in colorectal cancer. College of American Pathologists Consensus Statement 1999. Arch Pathol Lab Med 2000; 124:979.
  19. McGory ML, Shekelle PG, Ko CY. Development of quality indicators for patients undergoing colorectal cancer surgery. J Natl Cancer Inst 2006; 98:1623.
  20. Otchy D, Hyman NH, Simmang C, et al. Practice parameters for colon cancer. Dis Colon Rectum 2004; 47:1269.
  21. Data from US Nationwide Prospective Cohort Studies. Predictors of lymph node count in colorectal cancer resections. Arch Surg 2012, 147:715.
  22. Bembenek AE, Rosenberg R, Wagler E, et al. Sentinel lymph node biopsy in colon cancer: a prospective multicenter trial. Ann Surg 2007; 245:858.
  23. Bilchik AJ, Hoon DS, Saha S, et al. Prognostic impact of micrometastases in colon cancer: interim results of a prospective multicenter trial. Ann Surg 2007; 246:568.
  24. Stojadinovic A, Nissan A, Protic M, et al. Prospective randomized study comparing sentinel lymph node evaluation with standard pathologic evaluation for the staging of colon carcinoma: results from the United States Military Cancer Institute Clinical Trials Group Study GI-01. Ann Surg 2007; 245:846.
  25. de Haas RJ, Wicherts DA, Hobbelink MG, et al. Sentinel lymph node mapping in colon cancer: current status. Ann Surg Oncol 2007; 14:1070.
  26. Redston M, Compton CC, Miedema BW, et al. Analysis of micrometastatic disease in sentinel lymph nodes from resectable colon cancer: results of Cancer and Leukemia Group B Trial 80001. J Clin Oncol 2006; 24:878.
  27. Lim SJ, Feig BW, Wang H, et al. Sentinel lymph node evaluation does not improve staging accuracy in colon cancer. Ann Surg Oncol 2008; 15:46.
  28. Faerden AE, Sjo OH, Andersen SN, et al. Sentinel node mapping does not improve staging of lymph node metastasis in colonic cancer. Dis Colon Rectum 2008; 51:891.
  29. Cahill RA, Bembenek A, Sirop S, et al. Sentinel node biopsy for the individualization of surgical strategy for cure of early-stage colon cancer. Ann Surg Oncol 2009; 16:2170.
  30. Segelman J, Flöter-Rådestad A, Hellborg H, et al. Epidemiology and prognosis of ovarian metastases in colorectal cancer. Br J Surg 2010; 97:1704.
  31. Chang GJ and Feig BW. Chapter 11. Cancer of the Colon, Rectum, and Anus. In: The M.D. Anderson Surgical Oncology Handbook, 4th, Feig BW, Berger DH, Fuhrman GM. (Eds), Lippincott Williams & Wilkins, Philadelphia 2006. p.261.
  32. Chong CS, Huh JW, Oh BY, et al. Operative Method for Transverse Colon Carcinoma: Transverse Colectomy Versus Extended Colectomy. Dis Colon Rectum 2016; 59:630.
  33. Lopez MJ. Multivisceral resections for colorectal cancer. J Surg Oncol 2001; 76:1.
  34. Nakafusa Y, Tanaka T, Tanaka M, et al. Comparison of multivisceral resection and standard operation for locally advanced colorectal cancer: analysis of prognostic factors for short-term and long-term outcome. Dis Colon Rectum 2004; 47:2055.
  35. Rowe VL, Frost DB, Huang S. Extended resection for locally advanced colorectal carcinoma. Ann Surg Oncol 1997; 4:131.
  36. Lehnert T, Methner M, Pollok A, et al. Multivisceral resection for locally advanced primary colon and rectal cancer: an analysis of prognostic factors in 201 patients. Ann Surg 2002; 235:217.
  37. Luna-Pérez P, Rodríguez-Ramírez SE, De la Barrera MG, et al. Multivisceral resection for colon cancer. J Surg Oncol 2002; 80:100.
  38. Govindarajan A, Coburn NG, Kiss A, et al. Population-based assessment of the surgical management of locally advanced colorectal cancer. J Natl Cancer Inst 2006; 98:1474.
  39. Darakhshan A, Lin BP, Chan C, et al. Correlates and outcomes of tumor adherence in resected colonic and rectal cancers. Ann Surg 2008; 247:650.
  40. Poultsides GA, Servais EL, Saltz LB, et al. Outcome of primary tumor in patients with synchronous stage IV colorectal cancer receiving combination chemotherapy without surgery as initial treatment. J Clin Oncol 2009; 27:3379.
  41. Scoggins CR, Meszoely IM, Blanke CD, et al. Nonoperative management of primary colorectal cancer in patients with stage IV disease. Ann Surg Oncol 1999; 6:651.
  42. Scheer MG, Sloots CE, van der Wilt GJ, Ruers TJ. Management of patients with asymptomatic colorectal cancer and synchronous irresectable metastases. Ann Oncol 2008; 19:1829.
  43. Nitzkorski JR, Farma JM, Watson JC, et al. Outcome and natural history of patients with stage IV colorectal cancer receiving chemotherapy without primary tumor resection. Ann Surg Oncol 2012; 19:379.
  44. Cirocchi R, Trastulli S, Abraha I, et al. Non-resection versus resection for an asymptomatic primary tumour in patients with unresectable stage IV colorectal cancer. Cochrane Database Syst Rev 2012; :CD008997.
  45. Lee YM, Law WL, Chu KW, Poon RT. Emergency surgery for obstructing colorectal cancers: a comparison between right-sided and left-sided lesions. J Am Coll Surg 2001; 192:719.
  46. Chiappa A, Zbar A, Biella F, Staudacher C. One-stage resection and primary anastomosis following acute obstruction of the left colon for cancer. Am Surg 2000; 66:619.
  47. Hida K, Hasegawa S, Kinjo Y, et al. Open versus laparoscopic resection of primary tumor for incurable stage IV colorectal cancer: a large multicenter consecutive patients cohort study. Ann Surg 2012; 255:929.
  48. Harris GJ, Church JM, Senagore AJ, et al. Factors affecting local recurrence of colonic adenocarcinoma. Dis Colon Rectum 2002; 45:1029.
  49. Sjövall A, Granath F, Cedermark B, et al. Loco-regional recurrence from colon cancer: a population-based study. Ann Surg Oncol 2007; 14:432.
  50. Manfredi S, Bouvier AM, Lepage C, et al. Incidence and patterns of recurrence after resection for cure of colonic cancer in a well defined population. Br J Surg 2006; 93:1115.
  51. Bowne WB, Lee B, Wong WD, et al. Operative salvage for locoregional recurrent colon cancer after curative resection: an analysis of 100 cases. Dis Colon Rectum 2005; 48:897.
  52. National Comprehensive Cancer Network (NCCN). NCCN Clinical practice guidelines in oncology. http://www.nccn.org/professionals/physician_gls/f_guidelines.asp (Accessed on February 27, 2016).