Management & Treatment

Surgical Management Goals for surgical management include: Eliminating complications (intestinal obstruction) Removing the diseased colonic segment Restoring intestinal continuity

Total & Subtotal Colectomy Required in patients with: *fulminant colitis *attenuated familial adenomatous polyposis *synchronous colon carcinomas

Total & Subtotal Colectomy The following is ligated & divided: *ileocolic vessels *right colic vessels *middle colic vessels *left colic vessels Superior rectal vessels are preserved

A subtotal colectomy is performed A subtotal colectomy is performed. Histopath reveals a full thickness moderately differentiated adenocarcinoma with 2 out of 16 positive pericolic lymph nodes. Both lines of resection are negative for tumor.

Preoperative Care - Urine output = 0.5ml/kg/hr 1. Intravenous Fluid Resuscitation - Lactated Ringer’s solution 2. Foley Catheter bladder drainage to assess urine output - Urine output = 0.5ml/kg/hr 3. Tube Decompression (Nasogastric suction) - reduce hazard of pulmonary aspiration of vomitus - minimize further intestinal distention from preoperatively swallowed air

Preoperative Care 4. Broad spectrum antibiotics - Bacterial infections - Prophylaxis for possible resection 5. Patient must not have anything to eat or drink the night before surgery 6. Patient should not take any aspirin or other anti-inflammatory for 10 days before surgery. - these drugs can interfere with the blood's ability to clot - may increase the amount of bleeding during and after surgery

Stage 3: Lymph node metastasis (TanyN1M0) *Chemoradiation - to control local recurrence after resection - prolongs survival - 5-Fluorouracil-based regimens (w/ Leucovirin) 1. Preoperative radiation - tumor shrinkage - tumor downstaging by treating locally involved lymph nodes 2. Postoperative radiation - accurate pathologic staging of the resected tumor & lymph nodes - avoids wound healing problems associated with preoperative radiation

Follow-up & Surveillance The goal of close follow-up observation: - to detect resectable recurrence - to improve survival *Colonoscopy *Endorectal ultrasound examinations