Rahul, a 65-yrs-old man is admitted to the hospital with complaints of intermittent constipation and microcytic anemia. Barium enema reveals a non obstructing apple core lesion of the proximal sigmoid colon. Colonoscopy confirms the location of the mass and reveals no other synchronous lesions. Treatment of choice is?
|D||5-fluorouracil and leucovorin|
a. The extent of resection is determined by the location of the cancer, its blood supply and draining lymphatic system, and the presence or absence of direct extension into adjacent organs.
b. It is important to resect the lymphatics (which parallel the arterial supply) to the greatest extent possible in order to render the abdomen free of lymphatic metastases if possible.
c. Should hepatic metastases subsequently be detected, they may still be resected for cure in some instances if the abdominal disease has been completed eradicated.
d. To restore the continuity of the gastrointestinal tract, an anastomosis is fashioned with either sutures or staples, joining the ends of the intestine (small or large).
e. It is important that both segments of the intestine used for the anastomosis have excellent blood supply and that there be no tension on the anastomosis.
f. For lesions involving the cecum, ascending colon, and hepatic flexure, a right hemicolectomy is the procedure of choice.
g. This involves removal of the bowel from 4 to 6 cm proximal to the ileocecal valve to the portion of the transverse colon supplied by the right branch of the middle colic artery.
h. An extended right hemicolectomy is the procedure of choice for most transverse colon lesions and involves division of the right and middle colic arteries at their origin, with removal of the right and transverse colon supplied by these vessels.
i. The anastomosis is fashioned between the terminal ileum and the proximal left colon.
j. A left hemicolectomy (i.e., resection from the splenic flexure to the rectosigmoid junction) is the procedure of choice for tumors of the descending colon, whereas a sigmoidectomy is appropriate for tumors of the sigmoid colon.