QuestionSBA
QuestionChoice
Transverse colectomies are not often undertaken due to this being a complex surgery, as the colon has a complicated blood supply. An extended right hemicolectomy is the best option.
10035423
b
Transverse colectomy
QuestionChoice
This would be the most appropriate option. A right hemicolectomy involves the resection of a portion of the distal ileum, caecum, ascending colon, and proximal to mid-transverse colon. As the tumour is at the hepatic flexure, this would be resected. A primary anastomosis between the ileum and remaining colon is often made unless there are surgical complications necessitating temporary stoma formation.
10035422
a
Right hemicolectomy with ileocolic anastamosis
QuestionChoice
While an extended right hemicolectomy would remove the tumour (this is the same as a right hemicolectomy but extended to the splenic flexure), this would be more extensive than required as the patient's tumour is at the hepatic flexure, and therefore be a higher risk procedure. Formation of an ileostomy would not be ideal unless a surgical complication meant that a primary anastomosis was not possible.
10035424
c
Extended right hemicolectomy and temporary ileostomy
QuestionChoice
There is no indication to remove the whole colon, which is a higher-risk procedure. The tumour is confined to the hepatic flexure, and therefore a right hemicolectomy would suffice.
10035426
e
Total colectomy
QuestionChoice
A Hartmann's procedure involves surgical resection of the rectosigmoid colon with closure of the anorectal stump and formation of an end colostomy. This is typically an emergency procedure performed due to a sigmoid perforation (e.g. due to diverticulitis) or an obstructing sigmoid tumour. It is not suitable for right-sided colon cancer.
10035425
d
Hartmann's procedure
Concept
Chapter
2693
4239
Colorectal Cancer
Topic
135
General surgery
19488
Right hemicolectomy is the standard surgical treatment for tumours located at the hepatic flexure of the colon.
A 68-year-old previously fit and well woman is diagnosed with colorectal cancer at the hepatic flexure during a colonoscopy performed due to a positive bowel cancer screening (FIT) test.

Subsequent investigations show that the tumour has not metastasised or breached the intestinal wall.

Which of the following is the most suitable surgical approach?
a