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General Surgery


Answer 1
  1. Exploratory laparotomy with colon resection. The patient should be scheduled for colon resection. The goals of surgical excision of colon cancer are to both cure the disease and alleviate symptoms.
    Even if there is metastatic disease at the time of surgery, it is important to remove the primary tumor to prevent complications (eg, obstruction, bleeding). Therefore, a metastatic workup with CT or liver function testing to preoperatively stage the patient is typically not warranted. It is more important to rule out a synchronous lesion via colonoscopy. Patients with stage III cancer can be treated with chemotherapy—eg, 5-FU and levamisole. Patients with stage I and low-risk stage II cancers do not need additional therapy. Radiation therapy is ineffective as adjuvant therapy for patients with colon cancer; radiation therapy is only beneficial in patients with rectal cancer.
    Using laparoscopic operative techniques in the treatment of cancer has raised considerable concern. A laparoscopic colectomy could compromise cancer control by several mechanisms, including inadequate lymphadenectomy, inadequate intraoperative staging, and seeding of tumor at port or specimen extraction sites. Currently, a national prospective randomized trial is in progress to determine the role of laparoscopy in cancer surgery. Until then, laparoscopic colon resection for cancer should be reserved for use in a research setting.

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