Missing elements of modern management

Ballinger and Anggiansah's review of the management of colorectal cancer made little or no mention of important aspects of current treatment.¹

They did not mention the role of laparoscopic large bowel resection for colorectal cancers, which has become increasingly widely used in the United Kingdom and abroad and is now recommended as an alternative to open surgery by the National Institute for Health and Clinical Excellence (NICE ).² A recent study has shown that laparoscopic surgery allows rapid mobilisation of the patient, an earlier return of bowel function, lower complication rates and a much earlier discharge from hospital (4 days v 11 days).³

Secondly, liver resection, for unilobar or bilobar colorectal tumour metastases, has revolutionised treatment of the condition yet only merits one sentence. Up to 50% of patients with colorectal cancers develop liver metastases after diagnosis. Chemotherapy has been shown to extend median survival. However, without liver resection, five year survivors are extremely rare. Some units are achieving a five year survival of 46% with low mortality (2.1%) and morbidity.⁴ The use of neoadjuvant chemotherapy before liver resection, avoidance of perioperative blood transfusion, and meticulous surgical technique may all have contributed to this success story.