Surgical management of sporadic colon cancer, familial adenomatous polyposis, and hereditary nonpolyposis colon cancer

Background: Surgical management is the primary treatment of potentially curable colon cancer. In most cases, this involves resection of the primary tumor and regional lymph nodes. However, treatment options may include endoscopic polypectomy for malignant polyps; laparoscopically assisted colectomy in carefully selected patients; as well as multimodality management for locally advanced cancers. The prevailing objective throughout is to maximize both oncologic and functional results. Methods: An overview of selected aspects of the standard surgical management of primary sporadic colon cancer, familial adenomatous polyposis (FAP), and hereditary nonpolyposis colon cancer (HNPCC) is presented. Results: Results of clinical trials are discussed. Conclusions: Invasive adenocarcinomas require ligation and resection of the lymphovascular pedicle directly draining the intestinal segment containing the tumor. En bloc resections, oophorectomies, extended resections, and prophylactic colectomies are required in selected patients. Large-scale prospective, randomized trials are currently underway to establish the true risks and benefits of a laparoscopically assisted colectomy. Prophylactic colectomies should be performed for FAP patients and should be considered on a patient-by-patient basis in HNPCC mutation carriers depending on clinical features.