Surgery for Locally Advanced GIT Cancers Has Potentially Good Postoperative Outcomes in a Tertiary Hospital.

Abstract

Adhesions and infiltration into adjacent tissues are present in about 12% of gastrointestinal (GIT) cancers. These adhesions have high potential risk of malignancy. Free resection margin is a predictor of good survival in such patients. This study aims at evaluating the post-operative outcomes after multi-visceral resection of locally advanced gastrointestinal cancers. Ninety patients who underwent extended and multi-visceral resection for GIT cancers invading or adhering to adjacent organs have been included. For gastric cancer, distal gastrectomy was performed for 12% of the cases and total gastrectomy in 20%. For recto-sigmoid cancer, anterior resection was performed in 18% and abdomino-perineal resection in 7%. Partial colectomy was performed for colonic cancer in 43% of the cases. One organ was excised with GIT tumor in 60 cases (67%). The other 30 cases (33%) required excision of more than one organ. Pathological invasion of adjacent organs was confirmed in 42% of cases. Free margins were obtained in 87% of patients. Morbidity rate was 51%. The most frequent complications were wound infection (17%), anastomotic leak (10%), and chest infection (10%). In this study, 19% required surgical re-intervention. Positive margin and positive lymph nodes (LNs) as well as mucoid adenocarcinoma were associated with a higher recurrence rate. Achieving free resection margins could be a safe and feasible procedure and may offer good prognosis when followed by adjuvant therapy for patients with locally advanced GIT cancer if patients were precisely selected to have procedure done in a high volume center.