Revised guidelines for second-look surgery in patients with colon and rectal cancer

Clin Transl Oncol. 2010 Sep;12(9):621-8. doi: 10.1007/s12094-010-0567-8.

Abstract

Proper indications for a second surgical intervention in patients with colorectal cancer have always been a controversial subject. Surgeons find benefit in a second-look operation where a limited extent of cancer is discovered and resected with negative margins. However, a negative exploratory laparotomy or an intervention that is unable to achieve an R0 resection provides little or no benefit. Unfortunately, this type of intervention may place the patient in a worse condition, leading to morbidity or mortality. This manuscript attempts to define clinical parameters of primary colorectal cancer that are associated with a pattern of recurrence and that can be definitively addressed by second-look surgery. Also, new surgical technologies that may assist in achieving a potentially curative resection of local-regional recurrence are described. Cytoreductive surgery with peritonectomy and perioperative intraperitoneal chemotherapy with hyperthermia is presented as a new treatment option for reoperative surgery. A new management plan utilized in patients at high risk for local-regional recurrence may result in a high likelihood of conversion of a second-look cancer-positive patient to a long-term survivor.

Publication types

  • Review

MeSH terms

  • Antineoplastic Agents / administration & dosage
  • Colorectal Neoplasms / drug therapy
  • Colorectal Neoplasms / pathology
  • Colorectal Neoplasms / surgery*
  • Digestive System Surgical Procedures / methods
  • Humans
  • Infusions, Parenteral
  • Neoplasm Recurrence, Local / drug therapy
  • Neoplasm Recurrence, Local / surgery*
  • Patient Care Planning / standards
  • Patient Selection
  • Practice Guidelines as Topic
  • Second-Look Surgery / standards*
  • Time Factors

Substances

  • Antineoplastic Agents