Operative Standards for Cancer Surgery: Colon Cancer

Oct 20, 2025

George Chang, MD, MS, MHCM, FACS, FASCRS, FSSO

Dr. George Chang is a leading expert in colon cancer surgery from MD Anderson Cancer Center. In a deep dive into operative standards, he discusses how tumor location impacts resection techniques. He shares insights on maximizing lymphadenectomy through proximal vascular ligation and offers tips for identifying key vessels to prevent injuries. The conversation includes practical advice on tumor localization and the nuances between different colectomy methods, emphasizing that meticulous surgical practices can significantly enhance patient outcomes.

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INSIGHT

Resection Follows Vascular Anatomy

Extent of colon resection is determined by tumor location and its feeding vessels, because lymphatic drainage follows arterial supply.
A complete oncologic resection removes the tumor, adequate bowel margin, and all regional lymph nodes tied to that vascular territory.

ADVICE

Perform Proximal Vascular Ligation

For right-sided tumors, ligate the ileocolic pedicle at or very near its origin at the SMA/SMV to achieve proximal vascular ligation.
Also identify and ligate a right colic or the right branch of the middle colic to ensure complete regional lymphadenectomy.

ADVICE

Use SMV-First Dissection Technique

Begin minimally invasive right colectomy by identifying the SMV via a transverse peritoneal incision and follow the anterior SMV plane.
Elevate the ileocolic pedicle and ligate vessels on the right side of the SMV to preserve a complete mesenteric envelope.

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