Primary therapy of carcinoma of the large bowel

Most colonic and rectal carcinomas are treated by excision, usually with the object of cure. Adequate and safe resection depends upon sound understanding of the anatomy and pathology of the tumor. The surgical options in various clinical situations are discussed but the final choice has to be individualized. Improved understanding of the biology of large bowel cancer and the advent of circular stapling devices have significantly altered the surgical practice in large bowel cancer. Despite these innovative advances, there has only been a modest improvement in survival over the last few decades. This is because the concept of "sequential tumor spread" does not always hold true. Systemic adjuvant therapy that is effective and safe is needed for selected patients. Notwithstanding, surgical resection remains the most effective therapy for large bowel cancer.