Surgery for cancer of the colon and rectum

Surgery is the cornerstone of treatment of primary colorectal cancer, independent of the patients age and extent of disease. In the case of locoregionally confined tumors, an en-bloc resection of the primary tumor and adequate lymph node dissection should be performed. However, this is still not generally done. A subtle surgical technique is the most important prophylaxis against local recurrences. Standardized operative techniques, extended resections and perioperative measures led to a reduction of the rate of palliative resections and to a reduction of perioperative mortality (approximately 3%). However, despite modern surgical approaches, the long term prognosis of patients with stage II/III was not essentially improved. Therefore, especially in these stages, a further improvement of the current situation can at best expected by perioperative chemotherapy +/-irradiation.