Surgical indications for different colon cancers

Surgery is the main method for treating colon cancer. Depending on the location of colon cancer, there are several main surgical methods.

1. Right hemicolectomy: suitable for cancers of the cecum, ascending colon, and hepatic flexure of the colon

Resection range: 15 to 20 cm of the terminal ileum, cecum, ascending colon and right half of the transverse colon, together with the associated mesentery and lymph nodes. Cancer of the hepatic flexure also requires resection of most of the transverse colon and lymph nodes of the right gastroepiploic artery. After resection, the ileum and colon need to be anastomosed end-to-end or end-to-side.

2. Left hemicolectomy: suitable for cancers of the descending colon and splenic flexure of the colon

Resection scope: left half of transverse colon, descending colon, part or all of sigmoid colon, together with its mesentery and lymph nodes. After resection, colon-to-colon or colon-to-rectum end-to-end anastomosis is performed.

3. Transverse colectomy: suitable for transverse colon cancer

Resection range: transverse colon and its hepatic and splenic flexures. After resection, end-to-end anastomosis of the ascending and descending colon is performed. If the anastomotic tension is too great, right hemicolectomy can be performed and ileocolic anastomosis can be performed.

4. Resection of sigmoid colon cancer

(1) Surgical principles for patients with intestinal obstruction: If the intestinal contents are significantly reduced after preoperative intestinal preparation and the patient's condition permits, a primary resection and anastomosis can be performed, but protective measures must be taken during the operation to minimize contamination. If the intestine is full and the patient's condition is poor, a colostomy can be performed proximal to the tumor first, and a secondary radical resection can be performed after the patient's condition improves.

(2) Principles of surgery when radical surgery is not possible: When the tumor has extensive local infiltration or is fixed to surrounding tissues and organs and cannot be removed, if the intestinal tract is already obstructed or may soon be obstructed, a short-circuit surgery between the distal and proximal sides of the tumor or a colostomy can be performed. If there is metastasis to distant organs and the local tumor can still be removed, local palliative resection can be used to relieve symptoms such as obstruction, chronic blood loss, infection and poisoning.