Actual standards and controversies on operative technique and lymph-node dissection in colorectal cancer.

BACKGROUND

Radical lymphadenectomy for colorectal cancer according to its arterial supply seems to remove potentially metastatic lymph nodes and highlights the impact on prognosis.

STANDARDS AND CONTROVERSIES

Systematic lymph-node dissection in colorectal cancer requires knowledge of normal anatomy of lymphatic drainage and spreading of lymph-node metastases. Oncological standards of curative surgery for colorectal cancer include en bloc resection, no-touch isolation technique, primary ligation of the vessels and systematic lymphadenectomy. In rectal cancer, total mesorectal excision and irrigation of the rectal stump is mandatory. Potential improvements in prognosis achieved by extended lymph-node dissection have to compete with procedure-related morbidity. High-tie ligation of the inferior mesenteric artery is a controversial issue. Prediction of prognosis is essential for planning a treatment schedule for patients.

CONCLUSIONS

At present, clinicopathological stage is the single most reliable factor in prediction of outcome. New encouraging methods for detecting micrometastases of lymph nodes and new surgical technologies such as immune corrective surgery are challenging and have to be critically assessed. The results of laparoscopic surgery for the cure of colorectal cancer have to be proven within prospective randomised trials.