Radical surgery with curative intent is the treatment of choice in the majority of colon cancers.
The basic surgical principles are removal of the major vascular pedicle feeding the tumor along with its lymphatics, obtaining a tumor-free margin, and en bloc resection of any organs or structures attached to the tumor.
True colonic mucosal recurrences are rare. More common are para-anastomotic recurrences reflecting possibly an inadequate lymphadenectomy.
It is therefore recommended that at least a 5-cm margin of normal bowel be obtained on either side of the tumor in order to minimize the possibility of an anastomotic recurrence.
254 For right-sided tumors, the length of ileum apparently does not influence the local recurrence rate.
254 Figures 106-2 and 106-3 note the extent of resection.
It is important to note that for tumors in the cecum, ascending colon, hepatic flexure, and proximal transverse colon, the right branch of the middle colic artery is divided along with the right colic and the ileocolic arteries. If the middle colic artery is ligated at its origin, consideration should be given to extend the resection of the bowel just to the distal third of the transverse colon in order to ensure viable bowel for the anastomosis.
Tumors in the transverse colon may require transverse colectomy or, at times, an extended right colectomy where the cecum, ascending colon, hepatic flexure, transverse colon, splenic flexure, and upper descending colon are resected together with its lymphatic drainage.
Descending and upper sigmoid colon cancers can be treated with left hemicolectomy with ligation of the IMA at its origin from the aorta or by segmental resections as long as the principles outlined above are followed.
