Colon cancer: special surgical considerations.

Three factors dictate the long-term clinical outcome of colon and rectal cancer surgery: (1) the biological characteristics of the malignancy; (2) the stage of the tumor; and (3) a combination of meticulous pre- and postoperative care with a skillfully performed surgical procedure which accomplished the complete removal of the primary malignancy and its regional lymphatic, as well as transmitted and vascular spread when feasible. The postoperative follow-up should include a comparison of the preoperation CEA value with monthly CEA determinations done every month for the first two years and every three months for the next three years. Two of three recurrences occur in the first two years and nine of ten recurrences occur before five years. After five years, and annual colonoscopy or barium enema plus CEA and careful physical examination will help detect the second primary which will occur more often in these patients than in a normal population.