What are the NCCN treatment guidelines for colon cancer?

Updated: Apr 10, 2020
  • Author: Elwyn C Cabebe, MD; Chief Editor: N Joseph Espat, MD, MS, FACS  more...
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Answer

Answer

National Comprehensive Cancer Network (NCCN) guidelines also recommend colectomy, with en bloc removal of regional lymph nodes, for treatment of resectable, nonobstructing colon cancer. [10] In addition, for clinical T4b disease, neoadjuvant chemotherapy may be considered. The NCCN states that laparoscopic-assisted colectomy may be considered, based upon the following criteria:

  • The surgeon has experience performing laparoscopically assisted colorectal operations
  • No locally advanced disease, acute bowel obstruction, or perforation from cancer is present
  • Thorough abdominal exploration is required
  •  Preoperative marking of small lesions should be considered 

NCCN recommendations for lymphadenectomy are as follows [10] :

  • Lymph nodes at the origin of feeding vessel should be identified for pathologic exam
  • Clinically positive lymph nodes outside the field of resection that are considered suspicious should be biopsied or removed, if possible
  • Positive nodes left behind indicate an incomplete (R2) resection
  • A minimum of 12 lymph nodes need to be examined to establish N stage

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