Colon cancer: specialized surgery

Yes. When the tumor is localized, or has metastases that can be removed, complete resection is the only route with curative intent. Chemotherapy accompanies surgery and reduces the risk of relapse, but does not replace it. That is why the first question with colorectal cancer is always whether it is operable.

In most cases, yes. It depends on the size and location of the tumor, previous surgery and the patient's condition. The minimally invasive approach reduces pain and shortens the hospital stay, but when it compromises the oncological quality of the resection, open surgery is chosen without hesitation.

Sphincter-preserving techniques are used whenever the distance to the anus and the response to treatment allow it. In some cases a permanent colostomy is necessary. Robotic surgery widens the possibilities of preservation in the narrow pelvis, but an individual assessment is essential before deciding.

Yes, in selected cases. Resection of the liver metastases, alone or combined with resection of the primary tumor, can offer long survival and even cure. What decides is not the number of lesions, but whether they can all be removed while leaving enough healthy liver in working condition.

HIPEC is indicated in selected cases of peritoneal carcinomatosis of colorectal origin, always combined with complete cytoreduction. After the PRODIGE 7 trial it stopped being used routinely for this origin, so the decision is made case by case by the multidisciplinary board.

As a general rule, once the staging workup has been completed, which determines whether the disease is localized or has spread. In locally advanced rectal cancer, chemoradiotherapy is usually given before surgery to shrink the tumor and allow an operation with a sufficient margin.

It depends mainly on the stage. In stages I and II, 5-year survival exceeds 80%, and in stage III, with adjuvant chemotherapy, it is between 60% and 70%. The quality of the resection and lymph node involvement are the other two decisive factors.

Regular check-ups with tumor markers (CEA), CT and colonoscopy, according to established protocols and for at least five years. The aim is twofold: to detect a relapse while it is still operable and to find new polyps before they turn into a second tumor.

Minimally invasive surgery reduces postoperative pain and complications compared with open surgery. ERAS enhanced recovery protocols, with early mobilization, early nutrition and pain control without excess opioids, shorten the hospital stay. Complications do occur, but they are less frequent in teams with volume.

At centers with proven experience in oncological colorectal surgery and enough case volume. It is worth asking how many operations of this kind the team performs each year and whether it has a multidisciplinary board. In this surgery, the team's volume translates directly into oncological and functional results.