Evaluation of a patient prior to second-look surgery

The evaluation of a patient with a suspected colorectal malignancy is well defined; however, the preoperative work-up of a patient who is a candidate for second-look surgery is controversial and based less on scientific evidence than on empiric or anecdotal grounds. The preoperative assessment of these patients can be divided into two phases. Phase I consists of a thorough history, physical examination, and routine laboratory tests as the most logical and traditional starting point. Phase II consists of specific tests aimed at evaluating the extent of the recurrence and the resectability of the tumor. Of the various modalities available, the enhanced computerized tomogram is currently the method most likely to provide significant information prior to carcinoembryonic antigen (CEA) -directed second-look surgery. The results of the preoperative evaluation together with a thorough understanding of the natural history of the disease will offer a clear perspective as to the most likely outcome.