Colorectal Cancer - Operative Principles

This academic review details the foundational principles and technical specifics of colectomy for colon cancer, emphasizing the oncologic triad of achieving negative circumferential margins, removing the entire mesentery, and accurate staging. We confirm the mandatory margin requirement is a minimum of 5 cm proximally and distally. We address localization challenges, detailing the critical technique for endoscopic tattooing using a saline bleb (0.5–1.0 ml) to contain the India ink and ensure strictly submucosal placement.The episode provides a deep dive into Complete Mesocolic Excision (CME), the standard requiring central vascular ligation and removal of the mesocolon within its intact envelope. CME significantly reduces recurrence and dramatically increases lymph node yield (median 38 nodes). We caution that this aggressive central dissection carries a specific risk of SMV injury (Superior Mesenteric Vein), cited at 1.6% in right hemicolectomies.Finally, the management of complex T4B disease (invasion of adjacent organs) is reviewed. We note that en block resection is required, and the FOX trot trial data now strongly supports considering neoadjuvant systemic therapy for clinical T4B colon cancer to achieve tumor downstaging and improve surgical outcomes.

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