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Treatment Option Overview for Colon Cancer

    Table 6. Standard Treatment Options for Stages 0–III Colon Cancer

    Stage (TNM Staging Criteria)Standard Treatment Options
    Stage 0 Colon CancerSurgery
    Stage I Colon CancerSurgery
    Stage II Colon CancerSurgery
    Stage III Colon CancerSurgery
    Adjuvant chemotherapy

    Table 7. Treatment Options for Stage IV and Recurrent Colon Cancer

    Stage (TNM Staging Criteria)Treatment Options
    Treatment of Liver MetastasisSurgery
    Neoadjuvant chemotherapy
    Local ablation
    Adjuvant chemotherapy
    Intra-arterial chemotherapy
    Treatment of Stage IV and Recurrent Colon CancerSurgery
    Chemotherapy and targeted therapy
    Second-line chemotherapy

    Primary Surgical Therapy

    Standard treatment for patients with colon cancer has been open surgical resection of the primary and regional lymph nodes for localized disease.

    The role of laparoscopic techniques [1,2,3,4] in the treatment of colon cancer has been examined in two studies.

    Evidence (laparoscopic techniques):

    1. A multicenter, prospective, randomized, noninferiority trial (NCCTG-934653) compared laparoscopic-assisted colectomy (LAC) with open colectomy in 872 patients.
      • At a median follow-up of 4.4 years, 3-year recurrence rates (16% LAC vs. 18% open colectomy; hazard ratio [HR] for recurrence, 0.86; 95% confidence interval [CI], 0.63–1.17; P = .32) and 3-year overall survival (OS) rates (86% LAC vs. 85% open colectomy; HR for death in LAC, 0.91; 95% CI, 0.68–1.21; P = .51) were similar in both groups for all stages of disease evaluated. Tumor recurrence in surgical incisions was less than 1% for both groups.[5][Level of evidence: 1iiA]
      • Decreased hospital stay (5 days LAC vs. 6 days open colectomy, P < .001) and decreased use of analgesics were reported in the LAC group. A 21% conversion rate from LAC to open procedure was shown.
      • This study excluded patients with locally advanced disease, transverse colon and rectal tumor locations, and perforated lesions. Each of the 66 surgeons participating in the trial had performed at least 20 LACs and were accredited for study participation after independent videotape review assured appropriate oncologic and surgical principles were maintained.[5] The quality-of-life component of this trial was published separately and minimal short-term quality-of-life benefits with LAC were reported.[6][Level of evidence: 1iiC]
    2. One small, single-institution randomized study of 219 patients showed that the LAC procedure was independently associated with reduced tumor recurrence on multivariate analysis.[7][Level of evidence: 1iiB]
      1|2|3

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