1. Management & Treatment

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

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

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

6. 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.

7. 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

8. 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

9. 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

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