The Optimal Extent of Intestinal Resection for Colorectal Cancer Surgery

Abstract

The optimal extent of intestinal resection was investigated for cancer control. Node metastases were examined by the clearing method in 164 patients with colon cancer and 198 patients with rectal cancer. For pericolic spread of colon cancer, the distance from the primary tumor to a metastatic node was within 7cm. For central spread of colon cancer, the rate of metastatis to main nodes was 11.6%. For rectal cancer, the rate of distal intramural spread was 10.6% and the maximum distal spread was 2cm. The metastatic rate in the distal mesorectum was 20.2% and the longest distal spread from the primary tumor to the metastatic node was 4cm. The rate of metastasis to pericolic nodes that lie along the last sigmoid artery was only 1.0%. In T1 colon cancer, central node dissection is not required, but 3-cm proximal and distal margins of resection are required. In T2, central node dissection that includes the intermediate node should be performed, and 5-cm proximal and distal margins of resection are required. In T3 and T4, central node dissection that includes the main node should be performed, and 7-cm proximal and distal margins of resection are required. A 3-cm distal mural resection is required for rectosigmoid and upper rectal cancer, a 2-cm distal mural resection for lower rectal cancr, and a 1-cm distal mural resection for T1 and T2. Total mesorectal excision is required for T3 and T4 in the lower rectum, and excision of all mesorectal tissue down to at least 5cm below the tumor is required for T3 and T4 in the upper rectum. A J-pouch can be constructed by using the sigmoid colon.