A 65-year-old man is admitted to the hospital with complaints of intermittent constipation and microcytic anemia. Barium enema reveals a non-obstructing "apple-core" lesion of the proximal sigmoid colon. Colonoscopy confirms the location of the mass and reveals no other synchronous lesions. Select the appropriate next step. (SELECT 1 STEP)
The patient has a left colon cancer. In order to resect the tumor with a margin of 3-5 cm on its proximal and distal ends as well as to remove the draining lymph node basin, a left hemicolectomy should be performed. A Dukes C tumor is one that extends through the bowel wall and involves adjacent lymph nodes. In a study of 1166 patients with stage B and C colon cancer, the National Surgical Adjuvant Breast and Bowel Project (NSABP) reported an improved survival in patients randomized to receive adjuvant chemotherapy compared with no further treatment after resection. Adjuvant radiation therapy has only been useful in preventing local recurrence in rectal cancers with positive surgical margins.The liver is the most common site of bloodborne metastases from primary colorectal cancers. In a subgroup of patients, the liver may be the only site of disease. Overall, surgical resection is associated with a 25-30% 5-year survival rate.
Left hemicolectomy
Right hemicolectomy
Subtotal colectomy
Total colectomy
Transplantation