Surgery for Locally Advanced Recurrent Colorectal Cancer Involving the Aortoiliac Axis

Abstract

Locally advanced, recurrent colorectal cancer involving the aortoiliac axis may be considered a contraindication for curative surgery because of the technical challenges of achieving a negative margin resection and an assumed poor prognosis. The aim of this study was to assess oncologic outcomes and the ability to achieve an R0 resection in these patients. A retrospective review of a prospectively maintained colorectal cancer database identified 406 consecutive patients who underwent surgery for locally recurrent colorectal cancer between 1997 and 2007. This study was conducted at an academic multidisciplinary tertiary center. The demographic and clinicopathological features of patients undergoing resection for locally advanced disease involving the aortoiliac axis at our institution were reviewed. Twelve patients (7 women, median age 51 years) were identified. Major vessel involvement included internal iliac artery (n = 7), common iliac artery (n = 5), external iliac artery (n = 3), aorta (n = 3), internal iliac vein (n = 2), and external iliac vein (n = 1). R0 resection was achieved in 7 patients, and R1 resection in 5. Eleven patients received intraoperative radiation therapy. Vascular reconstruction (3 aorta, 5 common iliac, 3 external iliac) included synthetic interposition grafts, femoral-femoral bypasses, or primary anastomosis. One patient underwent venous reconstruction of the external iliac vein. No graft complications were encountered, and graft patency at 4 years was 100%. Thirty-day morbidity was seen in 9 patients, 8 of whom had Clavien grade <3. Thirty-day mortality was nil. Overall and disease-free survival at 4 years was 55% and 45%. This study was limited by its sample size, retrospective design, and the number of outcome events. R0 resection of locally advanced recurrent colorectal cancer involving the aortoiliac axis was achieved in over 50% of patients. Overall and disease-free survival was comparable to outcomes seen with locally advanced disease to nonvascular structures.