Laparoscopic Resection Of Curable Colon And Rectal Cancer
Publication Date: February 1, 2012
Last Updated: March 14, 2022
Recommendations
Tumor localization
When approaching colon resection laparoscopically, every effort should be made to localize the tumor preoperatively. Small lesions should be marked endoscopically with permanent tattoos before surgery to maximize the surgeon’s ability to identify the lesion. Surgeons should be prepared to use colonoscopy intraoperatively if lesion localization is uncertain. (Low, Strong)
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Diagnostic evaluation for metastases
We recommend that for patients with colon or rectal cancer, the chest, abdomen, and pelvis be evaluated preoperatively with CT scan. In patients with rectal cancer, we also recommend preoperative locoregional staging with endorectal ultrasound or MRI. (Low, Strong)
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Preparation for operation
We suggest that preoperative mechanical bowel preparation be used to facilitate manipulation of the bowel during the laparoscopic approach and to facilitate intraoperative colonoscopy when needed. (Low, Weak)
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Surgical Technique – Colon
We recommend that laparoscopic resection follow standard oncologic principles: proximal ligation of the primary arterial supply to the segment harboring the cancer, appropriate proximal and distal margins, and adequate lymphadenectomy. (High, Strong)
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Surgical Technique – Rectum
We recommend that laparoscopic resection for rectal cancer follow standard oncologic principles: Adequate distal margin, ligation at the origin of the arterial supply for the involved rectal segment, and mesorectal excision. (Moderate, Strong)
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Contiguous Organ Attachment
For locally advanced adherent colon and rectal tumors, an en bloc resection is recommended. We suggest an open approach if a laparoscopic en bloc resection cannot be performed adequately. (Low, Weak)
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Obstructing Colon Cancer (Right-sided)
We recommend that patients with an obstructing right or transverse colon cancer undergo a right or extended right colectomy. The open approach is required if the laparoscopic approach will not result in an oncologically sound resection. (Low, Strong)
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Obstructing Colon Cancer (Left-sided)
We suggest that for patients with an obstructing left-sided colon cancer, the procedure be individualized according to clinical factors. Colonic stenting may increase the likelihood of completing a one-stage procedure and may decrease the likelihood of an end colostomy. (Moderate, Weak)
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Prevention of Wound Complications
The use of a wound protector at the extraction site and the irrigation of port sites and extraction site incisions may reduce abdominal wall cancer recurrences. (Low, Strong)
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Robotic Surgery
While robotic surgery for colon and rectal cancer appears feasible and safe, in the absence of long-term oncologic outcome studies, no clear recommendation can be made. (Low, Weak)
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Training and Experience
Before surgeons apply the laparoscopic approach for the resection of curable colon and rectal cancer, they must have adequate knowledge, training, and experience in laparoscopic techniques and oncologic principles. (Moderate, Strong)
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Recommendation Grading
Overview
Title
Laparoscopic Resection Of Curable Colon And Rectal Cancer
Authoring Organization
Society of American Gastrointestinal and Endoscopic Surgeons
Publication Month/Year
February 1, 2012
Last Updated Month/Year
January 8, 2024
Supplemental Implementation Tools
Document Type
Guideline
External Publication Status
Published
Country of Publication
US
Document Objectives
The following recommendations regarding the safe performance of laparoscopic resection for curable colon and rectal cancer are intended for surgeons experienced in both minimally invasive surgery and the surgical treatment of patients with colon and rectal cancer.
Target Patient Population
Patients with colon and rectal cancer
Inclusion Criteria
Female, Male, Adolescent, Adult, Older adult
Health Care Settings
Ambulatory, Hospital, Operating and recovery room, Outpatient
Intended Users
Nurse, nurse practitioner, physician, physician assistant
Scope
Management, Treatment
Diseases/Conditions (MeSH)
D003107 - Colorectal Surgery, D012004 - Rectal Neoplasms, D003110 - Colonic Neoplasms, D010535 - Laparoscopy
Keywords
colon cancer, colorectal cancer, Colorectal Surgery, colorectal neoplasm