Surgical considerations in colorectal cancer

The large bowel, functioning largely as a wast storage receptacle, and with its long mesentery permits wide local excision and liberal removal of the lymphatics and blood vessels following the principles of cancer surgery. Rectal lesions with no mesentery or peritoneum, located in the narrowing lower pelvic cone are exceptions. With improved general patient support, antibiotics and technical improvements, 5-year survival in patients with localized disease now approaches 70%. "No-touch" principles with early ligation of the vascular pedicle, constricting tapes above and below the lesion, and local management of the resected bowel margins, have presumably diminished the dissemination of tumor cells at operation and lessened the chance of local implantation. Abdominoperineal resection, first described by Miles in 1908, is being reassessed because operative mortality and morbidity with a permanent colostomy is high, especially in the elderly patient. Local treatment by electrofulgeration, cryosurgery or radiotherapy are under intensive study as possible alternatives to surgery. The overall national death rate has improved only slightly during recent years. Thus the search for effective systemic measures to destroy small foci of cancer cells beyond the surgeon's reach must continue at a vigorous pace.