Abstract
BackgroundLocally advanced colorectal cancers are best treated with multivisceral resections. The aim of this study is to evaluate early and late results after multivisceral resections.MethodsAll patients operated for primary colorectal cancer between 2001 and 2010 were -reviewed. These were compared within the patients underwent single organ and multivisceral resections: demographics, tumor and procedure related parameters, perioperative results, early oncological outcomes and 5-year survival.ResultsA total of 354 patients (59.6 ± 13.8 years old, 210 [59.3%] males) were abstracted. Ninety (25.4%) patients underwent multivisceral resections for clinical T4 tumors and en-bloc R0 resection was achieved in 82 (91.1%). Only 31 (34.4% and 8.8% of clinical T4 and all cancers, respectively) cases had actual adjacent organ invasions (pT4). Males (20%) had lower risk for locally advanced tumors than females (33.3%) (p < 0.05). PT4 cancers were more common, if the clinical T4 tumor is located in the colon (48.8% vs 21.3%; p < 0.01). Laparoscopy was seldom initiated and the risk of conversion was higher in clinical T4 tumors (p < 0.05). The rates of sphincter-saving procedures were not different. Operation time, bleeding and transfusion requirements increased when multivisceral resections were necessitated (p < 0.05), but hospital stay, complications and 30-day mortality rates were similar. The 5-year survival rates were identical (p > 0.05).ConclusionsClinical T4 tumors are not rare and more common in women. An actual invasion (pT4) may be observed in one third of all clinical T4 tumors, and more frequent in colon cancers. An en-bloc, R0, multivisceral resection may be achieved in most cases. Multivisceral resections do not alter the rates of sphincter-saving procedures, morbidity and 30-day mortality; do not worsen survival but increase operation time, intraoperative bleeding and perioperative transfusion requirements.
Highlights
Advanced colorectal cancers are best treated with multivisceral resections
This study aims to evaluate the results after multivisceral resections performed for the treatment of locally advanced colorectal cancers, and compare the outcomes with those obtained from standard resections
54 (13.2%) cases were excluded since their pathological examinations revealed dysplasia or insitu cancer without an invasion (n = 14; 3.4%), tumors other than adenocarcinomas (n = 5; 1.2%) or because the operation was performed for a recurrent disease (n = 35; 8.6%); leaving 354 patients (59.6 ± 13.8 years old, 210 [59.3%] males) for the further analyses
Summary
Advanced colorectal cancers are best treated with multivisceral resections. The aim of this study is to evaluate early and late results after multivisceral resections. A recent analysis by Ministry of Health has shown that the age standardized rates for colorectal cancer are 12.1 and 8.0 for men and women, making it the third and Surgery remains the principal treatment technique in most of the patients with colorectal cancer, even for the most of those with a locally advanced tumor. Since limited number of studies included comparative data and the results are conflicting, it remains unclear whether or not multivisceral resections are making worse the early postoperative non-oncological results compared to standard single organ removals. This study aims to evaluate the results after multivisceral resections performed for the treatment of locally advanced colorectal cancers, and compare the outcomes with those obtained from standard resections
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