Surgical technique and colorectal cancer: impaction on local recurrence and survival

The survival of patients with large bowel cancer continues to improve. This may be explained by an evolution in surgical technique for cancer resection. Survival statistics between 30% and 75% can be found for the same stage of disease by different surgeons and at different institutions. The absolute requirement for survival is a complete resection of cancer with free margins of dissection. The etiology of local recurrence was suggested to be spilled tumor cells from venous blood, trasected lymphatics or from tissue trauma at narrow margins of dissection. Blunt dissection technique may be responsible for an increased incidence of local recurrence and cancer related death especially in metastatically insufficient cancers. Although no touch technique may not be important, the wide dissection that it promotes is of benefit. Even if adjacent structures are involved, an anatomically disciplined en bloc sharp or electrosurgical dissection are the surgical techniques that are of paramount importance. Adjuvant intraperitoneal cytostatic agents may in the future be used to eliminate spilled tumor cells that may occur even though the surgical approach is optimized.