Surgery for Stage IV Colon Cancer (HIPEC)

Colon cancer is one of the most common malignancies of the gastrointestinal system. It occurs more in males than females. The stages of colon cancer run from stage I to stage IV in which stage IV is the most advanced.

1. Understanding Stage IV Cancer and Its Management

Stage IV cancer means that it has spread to most of the

viscera in the patients’ body ergo surgical approaches is mainly limited to palliative care and taking care of some of the symptoms such as persistent bloating, prolonged constipation and severe blood loss especially in the stool and into the abdominal cavity. Stage IVa consists of cancers that have spread into only one body organ while stage IVb consists of the cancer having metastasized into multiple organs in the body.

2. Indications

Stage IV colon cancer is an advanced stage of colon cancer. Surgery is majorly indicated to minimize the number of metastases and for palliative care to the patient to add them more days to the expected lifespan.

3. How is this procedure done

The surgical approaches for stage IV cancers are focused on cutting out the segments of the bowel that are heavily affected by the tumor as well as the distant metastasis such as those to the liver and the lungs. Lymphadenectomy is vital as lymphatic channels are the conduits through which the cancerous cells spread to other body organs and resecting them early enough minimizes the chances. A good surgical approach would also remove the nearby normal tissues during the surgical resection by slightly extending the margins of resection beyond that of the cancer site. This will greatly minimize the instances where micrometastasis are left unresected. In severally affected patients, a complete resection of the colon is done to add them much more time. Such patients will be required to have a long stay in the hospital and have an alternative mode of feeding. If the cancer has spread to the rectum, part or the entire rectum has to be cut off during the surgical procedure. It is of great importance to combine surgical therapy along with other adjuvant therapies such as radiotherapy and immunotherapy. These will greatly increase the chances of the body effectively taking up surgical cancer treatment in most patients. A colostomy bag is required by some of the patients based on the surgeons’ assessment after .the Colectomy procedure Laparoscopy is a modern technique which can offer all of these surgical treatment options but in a minimally invasive way possible which ensures that the patient gets a faster healing process and with fewer complications.

4. Risks of the procedure

Due to the advanced nature of the stage IV colon cancer, already more than enough blood has been lost by the patient and having an open surgery also causes blood loss and the patient should be well transfused to counter this blood loss. Sepsis due to the operation of the gastrointestinal system, prophylactic antibiotics should be given before the surgery.

5. Patient preparation

The patient has to be assessed if they are fit for any surgical procedure. This is done through a thorough history taking and physical examination. Additional laboratory tests also help in this process.The patient is required to have undergone radiological investigations such as the barium swallow to determine the extent of the underlying condition. The patient is then given prophylactic antibiotics before the surgery is done to prevent any infections.The patient is required to fast for a minimum of about 8-12 hours to avoid complications of the anesthesia. An Intravenous line is required to feed the required drugs into the body system of the patient. Because of the nature of the surgery, the patient is required to have a temporary urinary catheter to deliver the formed urine from the urinary bladder to prevent the bladder from becoming overfull during the surgery.

6. Recovery after surgery

The laparoscopic approach is associated with a better outcome in terms of time taken to recovery and the post-operative pain compared the open abdominal surgery which takes about 10 days for the patient to get discharged from the hospital and even longer for the healing process itself. Thromboprophylaxis and early ambulation of the patient is used to prevent the formation of blot clots. In cases of a much more aggressive approach, the patient is put in ICU to stabilize.

7. Outcomes after surgery

Without the surgery, a stage IV colon cancer patient normally has about 15% 5-year survival rates; the surgery comes in to offer comfort and some extension to the time interval before their death. Early screening and diagnosis of any type of cancer is key to preventing the fatalities of advanced stages of the disease.

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