Chapter 48 / Colon and Rectum 315

What is the surveillance

Physical exam, stool guaiac, CBC, CEA,

regimen?

LFTs (every 3 months for 3 years, then

every 6 months for 2 years), CXR every

6 months for 2 years and then yearly,

colonoscopy at years 1 and 3 postopera-

tively, CT scans directed by exam

Why is follow-up so

90% of colorectal recurrences are

important the first 3

within 3 years of surgery

postoperative years?

What are the most common

Colon cancer, diverticular disease,

causes of colonic obstruction

colonic volvulus

in the adult population?

What is the 5-year survival

33% (28%–50%)

rate after liver resection

with clean margins for colon

cancer liver metastasis?

What is the 5-year survival

0%

rate after diagnosis of

unresectable colon cancer

liver metastasis?

COLONIC AND RECTAL POLYPS

What are they?

Tissue growth into bowel lumen, usually

consisting of mucosa, submucosa, or both

How are they anatomically

Sessile (flat)

classified?

Pedunculated (on a stalk)

What are the histologic

classifications of the

following types:

Inflammatory

As in Crohn’s disease or ulcerative colitis

(pseudopolyp)?

Hamartomatous?

Normal tissue in abnormal configuration

Hyperplastic?

Benign—normal cells—no malignant

potential

Chapter 48 / Colon and Rectum 317

What is the treatment?

Endoscopic resection (snared) if polyps;

large sessile villous adenomas should be

removed with bowel resection and lymph

node resection

POLYPOSIS SYNDROMES

FAMILIAL POLYPOSIS

What is another name for

Familial adenomatous polyposis (FAP)

this condition?

What are the characteristics?

Hundreds of adenomatous polyps within

the rectum and colon that begin developing

at puberty; all undiagnosed; untreated

patients develop cancer by ages 40 to 50

What is the inheritance

Autosomal dominant (i.e., 50% of

pattern?

offspring)

What is the genetic defect?

APC (adenomatous polyposis coli) gene

What is the treatment?

Total proctocolectomy and ileostomy

Total colectomy and rectal mucosal

removal (mucosal proctectomy) and

ileoanal anastomosis

GARDNER’S SYNDROME

What are the

Neoplastic polyps of the small bowel

characteristics?

and colon; cancer by age 40 in 100% of

undiagnosed patients, as in FAP

What are the other

Desmoid tumors (in abdominal wall or

associated findings?

cavity), osteomas of skull (seen on x-ray),

sebaceous cysts, adrenal and thyroid

tumors, retroperitoneal fibrosis, duodenal

and periampullary tumors

How can the findings

Think of a gardener planting “SOD”:

associated with Gardner’s

Sebaceous cysts

syndrome be remembered?

Osteomas

Desmoid tumors

318 Section II / General Surgery

What is a desmoid tumor?

Tumor of the musculoaponeurotic sheath,

usually of the abdominal wall; benign, but

grows locally; treated by wide resection

What medications may

Tamoxifen, sulindac, steroids

slow the growth of a

desmoid tumor?

What is the inheritance

Varying degree of penetrance from an

pattern?

autosomal-dominant gene

What is the treatment of

Total proctocolectomy and ileostomy

colon polyps in patients with

Total colectomy and rectal mucosal

Gardner’s syndrome?

removal (mucosal proctectomy) and

ileoanal anastomosis

PEUTZ-JEGHERS’ SYNDROME

What are the

Hamartomas throughout the GI tract

characteristics?

(jejunum/ileum colon stomach)

What is the associated

Increased

cancer risk from polyps?

What is the associated

Ovarian cancer (granulosa cell tumor is

cancer risk for women with

most common)

Peutz-Jeghers?

What is the inheritance

Autosomal dominant

pattern?

What are the other signs?

Melanotic pigmentation (black/brown)

of buccal mucosa (mouth), lips, digits,

palms, feet (soles)

(Think: Peutz Pigmented)

What is the treatment?

Removal of polyps, if symptomatic (i.e.,

bleeding, intussusception, or obstruction)

or large ( 1.5 cm)

What are juvenile polyps?

Benign hamartomas in the small bowel

and colon; not premalignant; also known

as “retention polyps”