Multivisceral and standard resections in colorectal cancer

Hoffmann, Martin; Phillips, Carmen; Oevermann, E.; Killaitis, Claudia; Roblick, U. J.; Hildebrand, P.; Buerk, C.; Wolken, H.; Kujath, P.; Schloericke, Erik; Bruch, Hans–Peter

doi:10.1007/s00423-011-0854-z

Cited by 44 publications

(52 citation statements)

References 20 publications

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“…In this study, invasion of other organs was confirmed by pathological examination in 53.5% of the samples, which was similar to the majority of the other series (range 34 to 58%) 11. Peritumoral inflammation may result in adhesions that are indistinguishable from true malignant invasion of proximal organs and structures during the surgical procedure.…”

Section: Discussionsupporting

confidence: 88%

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Prognostic factors affecting outcomes in multivisceral en bloc resection for colorectal cancer

Nahas

Ribeiro

et al. 2017

Clinics

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OBJECTIVES:This study sought to determine the clinical and pathological factors associated with perioperative morbidity, mortality and oncological outcomes after multivisceral en bloc resection in patients with colorectal cancer.METHODS:Between January 2009 and February 2014, 105 patients with primary colorectal cancer selected for multivisceral resection were identified from a prospective database. Clinical and pathological factors, perioperative morbidity and mortality and outcomes were obtained from medical records. Estimated local recurrence and overall survival were compared using the log-rank method, and Cox regression analysis was used to determine the independence of the studied parameters. ClinicalTrials.gov: NCT02859155.RESULTS:The median age of the patients was 60 (range 23-86) years, 66.7% were female, 80% of tumors were located in the rectum, 11.4% had stage-IV disease, and 54.3% received neoadjuvant chemoradiotherapy. The organs most frequently resected were ovaries and annexes (37%). Additionally, 30.5% of patients received abdominoperineal resection. Invasion of other organs was confirmed histologically in 53.5% of patients, and R0 resection was obtained in 72% of patients. The overall morbidity rate of patients in this study was 37.1%. Ureter resection and intraoperative blood transfusion were independently associated with an increased number of complications. The 30-day postoperative mortality rate was 1.9%. After 27 (range 5-57) months of follow-up, the mortality and local recurrence rates were 23% and 15%, respectively. Positive margins were associated with a higher recurrence rate. Positive margins, lymph node involvement, stage III/IV disease, and stage IV disease alone were associated with lower overall survival rates. On multivariate analysis, the only factor associated with reduced survival was lymph node involvement.CONCLUSIONS:Multivisceral en bloc resection for primary colorectal cancer can be performed with acceptable rates of morbidity and mortality and may lead to favorable oncological outcomes.

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Section: Discussionsupporting

confidence: 88%

“…However, the two series with predominantly male patients reported morbidity rates of 24% and 50% 3,10. These results were not significantly different from those of studies not composed predominantly of male patients, such as the current study (morbidity ranged from 25-48%) 9,11-13.…”

Section: Discussioncontrasting

confidence: 69%

Prognostic factors affecting outcomes in multivisceral en bloc resection for colorectal cancer

Nahas

Ribeiro

et al. 2017

Clinics

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“…Despite extensive preoperative evaluation, the decision to perform a multivisceral resection is often made intraoperatively [3]. The cornerstones of managing patients with multivisceral disease are a meticulous search for metastases, a wide en bloc resection and minimal tumour manipulation [23,32].…”

Section: Colonmentioning

confidence: 99%

“…About 10% of all colorectal cancers are either adherent to or invading contiguous organs at presentation [2,3]. Of the estimated 180,000 cases of colorectal cancer annually diagnosed in the EU, approximately 15% are locally advanced, and isolated locoregional recurrence occurs in approximately 5%.…”

Section: Introductionmentioning

confidence: 99%

Multivisceral Resection for T4 or Recurrent Colorectal Cancer

Larkin

O'Connell²

2012

Dig Dis

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Background: Approximately 10% of patients with colorectal cancer have locally advanced disease with peritoneal involvement (T4a) or invasion of adjacent organs (T4b) at the time of diagnosis. Of patients who undergo resection with curative intent, between 7 and 33% develop isolated locoregional recurrences. R0 surgical excision is potentially curative. Methods: We reviewed the literature relating to multivisceral resection for T4 or recurrent colorectal cancer. Results: Comprehensive staging to identify the local and systemic extent of disease is essential to determine resectability and patient suitability for a curative approach. PET scans and pelvic MRI (rectal) staging and a coordinated multispecialty input to neoadjuvant treatment, multivisceral surgical resection, reconstruction and adjuvant chemotherapy are essential. Intraoperative radiotherapy and hyperthermic intraperitoneal chemotherapy may have a role in selected patients. R0 resection can achieve 5-year local control rates for primary locally advanced and recurrent colorectal cancer of up to 89 and 38%, respectively, and overall 5-year survival up to 66 and 25%, respectively. Conclusion: An aggressive surgical strategy as part of a multimodal strategy in the treatment of locally advanced or recurrent colorectal cancer in the absence of incurable metastatic disease affords the best prospect for long-term survival in selected patients.

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“…Minimal invasive surgery reproduced similar long-term outcomes to those after open colectomy for primary cancer. It is anticipated that minimal invasive surgery will become the standard of treatment for locally advanced primary cancers [14,15]. A laparoscopic approach in recurrent cancers is controversial as previous laparotomies increase its difficulty.…”

Section: Technical Aspects and Detailsmentioning

confidence: 99%

Surgical options for locally recurrent rectal cancer—review and update

Troja

El-Sourani

Abdou

et al. 2015

Int J Colorectal Dis

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Locally recurrent rectal tumours in the pelvis are found in about 6% following treatment for rectal cancer. This type of tumour can cause serious local complications and symptoms. The aim of modern surgical oncology is to offer a curative treatment option embedded in an interdisciplinary network of specialities to the patient. Due to advancements in surgical techniques and procedures, especially regarding surgical reconstruction, the possibilities of a curative treatment regarding recurrent cancers have been expanded and established. To aim for a curative treatment one must introduce a multimodal therapy including radio- and chemotherapy, and a radical oncological surgery with en bloc resection of the tumour and affected surrounding organs to achieve a R0-resection.

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Multivisceral and standard resections in colorectal cancer

Abstract: Multivisceral resections are associated with the same 5-year survival as standard resections. Therefore, the aim to perform a R0 resection should always be the main goal in surgery for colorectal cancer. In planned operations, a laparoscopic approach is justified in selected patients.

Cited by 44 publications

References 20 publications

Prognostic factors affecting outcomes in multivisceral en bloc resection for colorectal cancer

Prognostic factors affecting outcomes in multivisceral en bloc resection for colorectal cancer

Multivisceral Resection for T4 or Recurrent Colorectal Cancer

Surgical options for locally recurrent rectal cancer—review and update

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