How Surgical Expertise Defines Colorectal Cancer Survival Outcomes

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• The Surgeon as a Key Prognostic Factor
• Anatomical Principles in Cancer Surgery
• Impact of Accurate Lymph Node Staging
• Surgical Quality and Survival Rates
• Improving Outcomes in Advanced Cancer
• Full Transcript

The Surgeon as a Key Prognostic Factor

Dr. Christoph Maurer, MD, states that the surgeon is one of the most important prognostic factors for patients with colon cancer. This is because surgical technique directly influences the risk of local recurrence and metastatic spread. The quality of the operation can alter a patient's cancer stage and subsequent treatment needs. Dr. Anton Titov, MD, discusses how this critical factor is often overlooked by patients seeking treatment.

Anatomical Principles in Cancer Surgery

Dr. Christoph Maurer, MD, explains that respecting anatomical planes is fundamental to curative cancer surgery. For rectal cancer, this involves the complete removal of the mesorectum, the fatty tissue containing crucial lymph nodes. The dissection must occur along the correct anatomical plane, the mesorectal fascia, to avoid tumor spillage. The same principle applies to colon cancer, where the mesocolon must be removed intact without being opened during the operation.

Impact of Accurate Lymph Node Staging

A precise surgical technique enables accurate intraoperative lymph-node staging. Dr. Christoph Maurer, MD, notes that this can result in upstaging for 15 to 30% of patients. Moving a patient from stage 2 to stage 3 colorectal cancer means they will require adjuvant chemotherapy. This staging accuracy is entirely dependent on the surgeon's skill in performing a radical and complete lymphadenectomy.

Surgical Quality and Survival Rates

The method of colon cancer resection has a profound effect on long-term survival. Dr. Christoph Maurer, MD, highlights that certain inferior surgical techniques can decrease 5-year survival expectancy by up to 40%. Central dissection of the blood vessels is essential, as lymph nodes follow the arterial supply. For a right-sided colon cancer, this means dissecting the ileocolic artery at its origin on the superior mesenteric artery to ensure radical removal.

Improving Outcomes in Advanced Cancer

A highly skilled cancer surgeon can achieve remarkable outcomes even in advanced disease. Dr. Christoph Maurer, MD, observes that a good surgeon can give stage 3 colon cancer patients almost the same long-term survival as stage 2 patients. This is achieved by completely removing all local and regional lymphatic cancer spread. Dr. Anton Titov, MD, and Dr. Maurer agree that this surgical principle of complete resection is more important than any additional chemotherapy for optimizing colon cancer survival.

Full Transcript

Surgeon is the most important prognosis factor in cancer treatment. How to select the best surgeon? What should the best surgeon know for cancer treatment? Patients sometimes overlook this most important cancer prognosis factor in their treatment.

Dr. Anton Titov, MD: Colorectal cancer best surgery options. You write in one of your reviews: "The surgeon is one of the most important prognostic factors for patients with colon cancer." "An accurate intraoperative lymph-node staging may result in upstaging 15 to 30% of patients." Moving a patient from stage 2 to stage 3 colorectal cancer means that patient will require adjuvant chemotherapy.

You also write that certain colon cancer resection techniques can actually worsen the prognosis for colon cancer survival. Certain colon cancer surgery methods can decrease 5-year survival expectancy in colon cancer patients for up to 40%. Why is the surgeon the most important prognostic factor for patients with colon cancer? How does the quality of the surgeon and the type of surgery affect long-term survival of patients with colorectal cancer?

Dr. Christoph Maurer, MD: Yes, so let's start with the example of rectal cancer. Twenty years ago we surgeons learned that the mesorectum is absolutely crucial to be removed during rectal cancer surgery. Mesorectum is the fatty tissue surrounding the rectum. Because within this mesorectum we have the lymph nodes.

We have to respect the anatomical planes of tissue. We have to respect the mesorectal fascia. And we have to dissect along this holy plane of rectal cancer surgery. The same is true for colon cancer. We have to respect the anatomical planes of mesocolon during colon cancer removal.

We have to leave intact both sides of the mesocolon. We have to avoid opening the mesocolon during surgical operation. Because otherwise we risk opening also the lymphatic vessels and the lymph nodes. This will result in colon or rectal cancer tumor spillage.

We have to do absolutely central dissection of the blood vessels. Because along the whole human body all the lymph nodes and the lymph vessels are following the arteries. So if you want to be radical with regard to lymphatic spread of colorectal cancer, we have to do a central dissection of the arteries.

That means for right-sided colon cancer, we have to dissect the ileocolic artery. We have to dissect it completely centrally at the level of the superior mesenteric artery. The third thing is about quality of cancer surgery. We have to do en bloc resections. We have to avoid opening of the tumor.

Dr. Anton Titov, MD: Previously we talked to prominent Swedish rectal cancer surgeon, Dr. Torbjorn Holm. We discussed the importance of knowledge of the best current cancer surgery techniques so that rectal cancer patients have the best survival rates. So it's very similar, in that sense, for the colon cancer surgery techniques too.

Dr. Christoph Maurer, MD: Exactly, exactly. A good cancer surgeon even in stage 3 colon cancer has almost the same long-term survival as in stage 2 colon cancer patients. Stage 3 colon cancer means cancer has involvement of the lymph nodes. Stage 2 colon cancer means there is no lymph node involvement.

Good surgeon improves stage 3 colorectal cancer survival because the surgeon is able to remove all local and regional lymphatic cancer spread. This surgical principle of complete lymph node removal is more important than any additional chemotherapy for colon cancer.

So it's worthwhile to adopt this structured concept to perform locoregional colorectal cancer resection radically.