Colorectal cancer: management

Question 1

Colorectal cancer: management

Answer 1

Caecal, ascending or proximal transverse colon: Right hemicolectomy

Distal transverse, descending colon Left: hemicolectomy

Sigmoid colon:
High anterior resection

Upper rectum:
Anterior resection (TME)

Low rectum:
Anterior resection (Low TME)

Anal verge:
Abdomino-perineal excision of rectum

Emergency surgery
Bowel has perforated the risk of an anastomosis is much greater, particularly when the anastomosis is colon-colon. In this situation, an end colostomy is often safer and can be reversed later. When resection of the sigmoid colon is performed and an end colostomy is fashioned the operation is referred to as a Hartmann’s procedure. Whilst left-sided resections are more risky, ileo-colic anastomoses are relatively safe even in the emergency setting and do not need to be defunctioned.