Surgery>>>>>Colon, Rectum, and Anus
Question 36#

A 67-year-old man presents to the ED with a 2-month history of nausea, emesis, 20-lb weight loss, and worsening diarrhea until 4 days ago, when he stopped passing flatus and having bowel movements. A CT scan shows a large obstructing right colon mass that may be involving the omentum with two liver lesions. What should be resected in this case?

a. Right hemicolectomy, involved omentum, and as many of the peritoneal masses you can
b. Right hemicolectomy with arterial supply and as many nodes as you can
c. Right hemicolectomy with arterial supply, at least 12 nodes, the involved omentum, and resectable liver masses
d. Don't do a colon resection. This patient has distant metastases and should be diverted for palliation

Correct Answer is C


The objective in treatment of carcinoma of the colon is to remove the primary tumor along with its lymphovascular supply. Because the lymphatics of the colon accompany the main arterial supply, the length of bowel resected depends on which vessels are supplying the segment involved with the cancer. Any adjacent organ or tissue, such as the omentum, that has been invaded should be resected en bloc with the tumor. If all of the tumor cannot be removed, a palliative procedure should be considered, although it important to note that "debulking" is rarely effective in colorectal adenocarcinoma. If the metastatic disease is low volume (isolated or potentially resectable liver lesions) and the resection of the primary tumor is straightforward (segmental abdominal colectomy), it is probably reasonable to proceed with resection. On the other hand, if the metastatic disease is high volume (carcinomatosis), especially if the primary tumor is minimally symptomatic, the operation should be aborted in order to facilitate early systemic chemotherapy.