Influence of surgical techniques on survival in patients with colorectal cancer.

This review was undertaken in an attempt to accumulate and critically evaluate all evidence that suggests that special techniques may alter survival rates of patients undergoing surgery for large-bowel cancer. Data suggesting reduced survival with a distal margin of resection less than 5 cm in patients undergoing anterior resection were found to be inconsistent. En bloc removal of the primary tumor and an adhesed adjacent structure seemed important, for 30 to 60 per cent survival has been reported using this approach, and adhesions were found to contain malignant cells at the interface of the primary tumor and adjacent structure in 40 to 100 per cent of patients. No statistically significant differences in survival rates were found in studies comparing conservative segmental bowel resection with radical hemicolectomy. This was true for colonic as well as rectal resections; while patient morbidity was not markedly increased for radical colectomy, it was found to be much greater with radical rectal resections. No data to support the use of "no-touch techniques" could be uncovered. Data to support the use of techniques for control of intraluminal tumor cells were sparse; however, because these maneuvers cost the patient little in terms of added morbidity, they should be used. Important aspects of the techniques for large-bowel surgery need to be investigated by prospective controlled clinical trials.