[Surgery of colorectal carcinoma]

Surgery is the primary mode of therapy for colonic and rectal cancer. The principles of surgery are: laparotomy for staging, wide en bloc resection of the primary tumor and lymphadenectomy for staging as well as possible therapeutic benefit. Reasonable efforts should be made intraoperatively to prevent intraluminal and intraperitoneal spread. Resection of metastases can prolong survival in stage D patients confined to the liver. Dukes C colon cancer patients should receive multiagent chemotherapy. There is no well defined role for radiation therapy as adjuvant treatment in colon cancer. Local failure pattern and treatment strategies are different for cancer of the rectum. Surgery remains the mainstay of treatment for all lesions; other modalities are adjunctive. Lesions within 5 cm of the anal verge usually require abdominoperineal resection, while the other are treated with a low anterior resection. New techniques are emerging to preserve the anal sphincter and gastrointestinal continuity, and these are being tested to determine if adequate tumor control is obtained.