Diagnosis of Adjacent Organ Invasion and Results from En Bloc Extended Resection for Locally Advanced Colorectal Cancer

Abstract

Purpose. Surgical treatment remains as the only hope of cure for the patient with colorectal cancer. Not infrequently the adjacent organs are invaded by the primary tumor. Resection of organs involved might not only relieve patient's symptoms, but also increase the patient's hope for cure. The study is the retrospective analysis of the diagnosis and treatment of such kind of invasion. Materials and Methods. From January 2000 to December 2009, 1583 cases of primary colorectal cancer were treated surgically by a single surgeon. Thirty-six patients (2.27%) had en bloc resection of locally advanced colorectal cancer with adjacent organ invasion. There were 17 men and 19 women. Age ranged from 28 to 84 years old, with an average of 60.9 years old. Enteral invasion occurred in 19 patients, urinary system involvement in fourteen patients and genital organ invasion in eight patients. Primary colorectal cancer were ten for rectal cancer, 20 for sigmoid cancer, four for descending colon cancer, one each for transverse colon and ascending colon cancer. Less than half of cases were diagnosed with image studies prior to surgery. Results. Complications included three cases of urinary tract infection, two cases of wound infection and one case each for anastomotic leakage, intestinal obstruction, wound dehiscence and duodenal ulcer with perforation. Operative mortality was 2.8% (1/36). Conclusion. This experience suggests that although direct invasion of the adjacent organ by primary colorectal cancer is not common, en bloc resection of the primary tumor with organ involved could be carried out with reasonable morbidity. Appropriate preoperative work up might detect some of the involvement, however, adequate exploration of the abdominal cavity during laparotomy is necessary to determine the extent of involvement. With help of multidisciplinary specialist, en bloc resection of involved organ offers the best interest for the patients.