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Colorectal cancer is one of the most common forms of cancer worldwide and is the second most common cancer in women and the third most common in men.  

90% of patients are over 50 years old at diagnosis, while in people with a genetic predisposition it may appear earlier. First-degree relatives of people with colon cancer have a higher risk of also developing colon cancer.  

Preventive screening for colorectal cancer plays a crucial role, as it reduces mortality, limits the incidence and increases detection at an early stage, with the possibility of radical treatment. Based on these data, the American College of Gastroenterology recommends preventive colonoscopy from the age of 45 for people without a family history or symptoms. Thus, through early detection and removal of precancerous lesions, the onset of cancer can often be prevented. 

Risk factors that increase the chances of occurrence are: 

• Family History

• Intestinal polyps, particularly in multiple (≥3) or large adenomas (>1 cm) 

• Inflammatory diseases of the intestine, such as ulcerative colitis. 

• The lack of physical exercise and obesity.

• Excessive consumption of red or processed meat. 

• Smoking and abuse alcohol.

Today, colorectal cancer is becoming very treatable. The prognosis of patients depends on the stage of the disease at diagnosis and on the site where it is found. In locally limited stages (UICC I-III) and even in cases with distant metastases (UICC IV), life expectancy is high. The average five-year survival rate is 65%, while if the cancer is diagnosed at an early limited stage (UICC I-III), the cure rate is 90%. This makes early diagnosis and prevention of utmost importance. 

Treatment is determined by the location of the tumor and the stage of the disease. Basically, for a holistic approach to treatment, it is recommended that each case be discussed in Interdisciplinary Oncology Councils, which constitute the golden rule in the management of oncological patients. 

The goal of treatment in locally limited stages is always a cure!

In colon cancer, surgery is the first therapeutic approach. In certain cases, such as in young patients, chemotherapy may be useful before surgery. 

Although overall colorectal cancer has been decreasing in recent years due to intensive prevention, the percentage of rectal tumors is increasing, which now account for approximately 35% and often affect younger patients. The rectum constitutes the last 15 centimeters of the intestine and is divided into three sections: the upper, middle and lower third. Tumors of the upper third are treated in the same way as those of the colon. In cases involving the middle and lower third, a combination of chemotherapy and radiotherapy is recommended for tumors in UICC stages II and III before surgery. Surgery always follows. Due to the close location to the sphincter, the creation of a parahedra may be required, which in most cases can be restored. Do not be afraid of the supernatural – even in these cases it is possible to live a normal life with high quality. 

After surgery, in stage III and subgroups of stage II, adjuvant chemotherapy may be necessary to reduce the risk of recurrence. The decision for this treatment should be discussed in the Interdisciplinary Oncology Council and should always be tailored to the needs of each patient (Tailored Approach). 

What do we do in advanced stages (IV);

For the majority of patients in stage IV, the primary goal of treatment is to control the cancer, that is, to relieve or avoid symptoms and to prolong survival. However, for a subgroup of patients, treatment at this stage is possible. condition, especially through repeated surgery for metastases, with the aim of cure. For drug therapy in stage IV, many different substances are available from the field of cytostatics, monoclonal antibodies and targeted therapy. 

Surgical treatment of the disease 

During surgery, oncologically correct and radical surgical removal of the part of the intestine carrying the tumor is of crucial importance. 

Fundamental principles of radical surgical removal: 

• Root removal of all relevant lymph node stations 

• Full excision of the mesocolic tissue (CME: CompleteMesocolic Excision) or the mesorectal tissue (TME: TotalMesorectal Excision) 

• Sufficient safety distance from volume

• Total removal of attached organs in the tumor (En Bloc Resection) 

Evidently, the prognosis of each patient depends on the number of lymph nodes removed and the quality of the complete resection of the mesocolic/mesorectal tissue (CME/TME), even in cases of carcinoma without positive lymph nodes. Therefore, the quality of the surgical procedure plays a decisive role in the quality of the treatment and the outcome. 

How should the procedure be performed technically today?

The choice of surgical approach, whether open with an abdominal incision, laparoscopically or even robotically, is a subject of intense debate, as the oncological quality of the laparoscopic technique is considered equivalent to that of open surgery. 

What advantages does it offer us? the robotic surgical technique compared to classical laparoscopy?

• Better and 3D visualization of the surgical field with 10x magnification. 

• Highest grade surgical precision, while providing great flexibility of movement: This is due to the robotic arms. which can make precise movements in confined spaces. 

• Minimize loss blood.

• Neuroprotective Surgery with as few functional problems as possible (such as urinary incontinence, erectile dysfunction). 

• Ergonomic and less burdensome surgery for the surgeon. 

New qualitative research highlights for the first time the advantages of robotic surgery in rectal cancer, so that the increasing application of robotic surgery is gaining more and more scientific ground. 

From my perspective, colorectal cancer should, if the patient’s condition allows, always be treated minimally invasively. Ideally, provided the surgeon has the appropriate expertise and experience, the operation should be performed robotically, in order to achieve the optimal oncological outcome.