• The sensitivity of CT scans in detecting metastatic lymphadenopathy ranges from 19 to 67 percent. Many series have reported the utility of CT in detection of liver metastases and cite sensitivities and specificities between 90 and 95 percent for lesions > 1 cm.
• There is a trend toward the routine use of preoperative evaluation of patients with CT scans, especially in cancer centers in which synchronous resections of the primary and metastatic cancers are increasing
• It is common practice among surgeons to obtain a chest x-ray preoperatively to evaluate the lungs for evidence of metastatic disease. Although the yield for metastatic disease is low, the cost is small, and the utility of the examination is part of an overall preoperative assessment
Preparation for Operation[2].
• All patients who are to undergo surgery for colon cancer need to be clearly informed of the reasons for and the extent of the proposed resection, the likely outcome of the surgery, the pertinent complications and their likelihood of occurring, expected length of hospitalization and recovery, alternatives to the proposed surgery, and prognosis
• Mechanical bowel preparation is nearly universal for elective surgery but outpatient bowel preparation can be safe and cost effective.
• Prophylactic antibiotics are recommended for patients undergoing colon resection
• Preoperative blood transfusions may be required for patients undergoing resection for colorectal cancer. The need for transfusion is primarily based on the starting hemoglobin, the patient's physiologic status, and extent of intraoperative blood loss.
• All patients undergoing surgery for colon cancer should receive prophylaxis against thromboembolic disease.


Operative Issues [2].
• The extent of resection of the colon should correspond to the lymphovascular drainage of the site of the colon cancer
• Tumors located in border zones should be resected with the neighboring lymphatic regions to encompass both possible directions of spread
• Laparoscopic-assisted colectomy may be considered based upon the following criteria:
• Surgeon with experience performing laparoscopically-assisted colorectal operations.
• No disease in rectum or prohibitive abdominal adhesions.
• No advanced local or metastatic disease.
• Not indicated for acute bowel obstruction or perforation from cancer.
• Thorough abdominal exploration is required
• Consider preoperative marking of small lesions.

• Synchronous colon cancers can be treated by two separate resections or subtotal colectomy
• Fifteen percent of patients with colon cancer will have tumors adherent to adjacent organs. They should be resected en bloc
• Between 10 and 20 percent of patients will have liver metastases at the time of their colon resection.
• Surgical excision or ablation of these tumors, when amenable, remains the only means of obtaining long-term survival in this group of patients. It is generally believed that such anatomic resections are best performed at a later date after recovery from the initial colonic resection.
• However, if at the time of the primary colon resection the patient is found to have limited metastatic disease in the liver, which is amenable to sub segmental resection or metastasectomy, it may be preferable to proceed with this additional procedure at the time of colectomy.
• Bilateral oophorectomy is advised when one or both ovaries are grossly abnormal or involved with contiguous extension of the colon cancer. However, prophylactic oophorectomy is not recommended
• Patients with an obstructing right or transverse colon cancer should undergo a right or extended right colectomy. A primary ileocolic anastomosis can be performed in the appropriate clinical setting
• The site of a colonic perforation caused by colon cancer should be resected, if at all possible