Colon surgery can be done via open surgery or via laparoscopic approach ('keyhole surgery'). The feasibility to perform via laparoscopic approach sometimes depends on the stage of the disease. For instance, a locally advanced disease may not be suitable for a laparoscopic approach.
In addition, the stage of the disease may also affect the timing of the surgery. For example, a stage 4 disease with distant sites of spread may benefit from a course of chemotherapy first before considering surgery especially if the colon cancer itself is not causing too much symptom.
On the other hand, for some stage 4 disease where the spread is limited to the liver, a combined liver and colon surgery may be advocated.
