4
Treatment
Table 3. Colon Cancer Stages IIB-IIC: T4N0
(Non-obstructing)
Population Intervention Setting
Patients with non-
obstructing, locally
advanced (ie., with
invasion of adjacent
structures) colon
cancer with emergent
symptoms
In an emergency, surgery performed by general
surgeons should be limited to life-saving
procedures (ie. segmental resection of bleeding or
perforated tumors). (Strong Recommendation;
IC-H)
Basic
Patients with non-
obstructing, locally
advanced (ie., with
invasion of adjacent
structures) colon
cancer
General surgeons should perform an open en
bloc resection following standard oncologic
principles. (Strong Recommendation; H)
Limited
Patients with non-
obstructing, locally
advanced (ie., with
invasion of adjacent
structures) colon
cancer
Colorectal surgeons and/or surgical oncologists
should perform a laparoscopic en bloc resection
following standard oncologic principles. (Strong
Recommendation; H)
Enhanced
Patients with non-
obstructing, locally
advanced (ie., with
invasion of adjacent
structures) colon
cancer
If a laparoscopic en bloc resection is not possible,
surgical oncologists and/or colorectal surgeons
should perform an open approach. (Strong
Recommendation; H)
Enhanced
and
Maximal
Patients with
non-obstructing,
resectable, locally
advanced (ie., with
invasion of adjacent
structures) colon
cancer
If there are no contraindications, surgical
oncologists and/or colorectal surgeons should
perform an en bloc resection following standard
oncologic principles using the most advanced
techniques. (Strong Recommendation; H)
Maximal
(cont'd)
