Multivisceral resection of advanced colorectal carcinoma

Gebhardt, C; Meyer, W.; Rückriegel, Stefan; Meier, U.

doi:10.1007/s004230050191

Cited by 110 publications

(127 citation statements)

References 16 publications

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“…In our study, malignant invasion was histologically confirmed in 60.9% of patients presenting with the primary tumor adherent to the adjacent organs. This finding is similar to previous reports (5,6). On the other hand, some previous studies demonstrated that adhesions between tumor and other organs harbor malignant cells in 25-40% of cases, which are lower rates compared with our study (2,7,8).…”

Section: Discussionsupporting

confidence: 92%

Multivisceral resections for locally advanced colorectal cancer after preoperative treatment

et al. 2018

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Abstract. Multivisceral resection for colorectal cancer invading into the adjacent organs may often be difficult and may involve serious complications. Preoperative therapy may facilitate resection with safe margins. Between August 2007 and July 2016, 23 patients with colorectal cancer invading into the adjacent organs treated with preoperative treatment (chemoradiotherpay, chemotherapy, radiotherapy) were retrospectively investigated. All 23 patients received surgery with curative intent. Four patients had distant metastases at the time of diagnosis. Two patients had distant metastasis after preoperative treatment. The mean operative time was 535.3±185.5 min and the median amount of blood loss was 1,050 ml. Histopathological examination revealed malignant infiltration of the adjacent organs in 14 patients (60.9%). R0 resection rate was 73.9%. Postoperative complications were identified in nine patients (39.1%) and a high incidence of infectious complications was observed. Patients with curative resection showed a significantly better survival than patients with R1 or R2 resection (P<0.01). Multivisceral resection for locally advanced colorectal cancer invading into the adjacent organ after preoperative treatment may be performed with acceptable morbidity and minimal mortality. R0 resection improves the prognosis of patients with locally advanced colorectal cancer invading into the adjacent organ after preoperative treatment.

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Section: Discussionsupporting

confidence: 92%

Multivisceral resections for locally advanced colorectal cancer after preoperative treatment

et al. 2018

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“…The affected organ should be resected en bloc with a safe margin of normal tissue. Patients who undergo a marginnegative multivisceral resection present survival that is similar to that of individuals with no adjacent organ involvement, on a stage-matched basis (6,7) . Locally advanced cancer of the right colon that adheres to the proximal duodenum or head of the pancreas presents a challenge, even for skilled surgeons.…”

Section: Introductionmentioning

confidence: 99%

En bloc pancreaticoduodenectomy and right hemicolectomy to treat locally advanced right colon cancer: report of three cases

Costa

Horta

Henriques

et al. 2010

Einstein (São Paulo)

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Although colorectal tumors are fairly common surgical conditions, 5 to 12% of these tumors are locally advanced (T4 tumors) upon diagnosis. In this particular situation, the efficacy of en bloc multivisceral resection has been proven. When right-colon cancer invades the proximal duodenum or even the pancreatic head, a challenging dilemma arises due to complexity of the curative surgical procedure. Therefore, en bloc pancreaticoduodenectomy with right hemicolectomy should be performed to obtain free margins. The present study reports three cases of locally advanced right-colon cancer invading the proximal duodenum. All of these cases underwent successful en bloc pancreaticoduodenectomy plus right hemicolectomy, with no death occurrence. Long-term survival was observed in two cases (30 and 50 months). In the third case, the patient did not present any recurrence twelve months after surgical treatment. Multivisceral resection with en bloc pancreaticoduodenectomy should be considered for patients who present acceptable risk for major surgery and no distant dissemination. This approach seems justified since the length of postoperative survival is longer in radically ressected groups (R0) than in palliativelly resected groups (R1-2).Keywords: Pancreaticoduodenectomy; Colorectal neoplasms; Colonic neoplasms; Adenocarcinoma; Case reports resUMo Embora os tumores colorretais sejam afecções cirúrgicas relativamente comuns, 5 a 12% dos casos são diagnosticados como localmente avançados (Tumores T4). Nessa situação particular, a eficácia da ressecção em monobloco já foi comprovada. Quando tumores do cólon direito invadem o duodeno proximal ou ainda a cabeça do pâncreas, um desafiador dilema é observado devido à complexidade do procedimento cirúrgico curativo. Dessa maneira, uma pancreaticoduodenectomia com hemicolectomia direita em monobloco deve ser realizada para se obterem margens livres. O presente artigo relata três casos de tumor de cólon direito localmente avançado com invasão do duodeno proximal. Todos esses casos foram submetidos à pancreaticoduodenectomia e hemicolectomia direita em monobloco de forma bem sucedida e sem mortalidade. Sobrevida em longo prazo foi observada em dois doentes (30 e 50 meses). No terceiro caso, o paciente não apresentava recidiva após 12 meses de seu tratamento cirúrgico. A ressecção multivisceral com pancreaticoduodenectomia em monobloco deve ser considerada em doentes com risco cirúrgico aceitável para cirurgia de grande porte e sem disseminação à distância. Essa conduta permanece justificada, pois a sobrevida a longo prazo dos doentes submetidos à ressecção radical (R0) é mais longa do que daqueles cuja ressecção é paliativa (R1-2).

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“…Antes de realizar uma ressecção multivisceral, a condição clínica do paciente e a presença ou não de metástases à distância devem ser consideradas. A taxa de mortalidade das ressecções em bloco é de 3% 3 . As ressecções multiviscerais em monobloco, associam-se com tempo de sobrevivência médio de 40 meses e taxa de sobrevivência em cinco anos livre de doença de 54%.…”

Section: Discussão Discussão Discussão Discussão Discussãounclassified

“…Já a sobrevivência média do "bypass" paliativo é de nove meses, e da ressecção incompleta, incluindo a ressecção com separação de órgãos é de 11 meses 4 . O longo período de sobrevivência após ressecções multiviscerais, pode ser explicado pela ausência de metástases em linfonodos regionais (N0), em 45% dos casos 5 , A literatura consultada, mostra que se o paciente tiver condições clínicas adequadas e não apresentar metástases à distân-cia, a ressecção multivisceral é o tratamento de escolha, mesmo quando a operação associada tem a magnitude e complexidade de uma duodenopancreatectomia [1][2][3][4][5] . O papel da quimioterapia adjuvante no tratamento de tumores localmente invasivos é incerto 4 .…”

Section: Discussão Discussão Discussão Discussão Discussãounclassified

“…Os tumores do cólon direito aderidos ao duodeno ou pâncreas representam um dilema para o cirurgião, devido à magnitude e a complexidade de uma duodenopancreatectomia associada a hemicolectomia direita 3 . O objetivo deste artigo é relatar um caso de câncer de cólon direito localmente avançado tratado com gastroduodenopancreatectomia cefálica associada a hemicolectomia direita em monobloco.…”

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Duodenopancreatectomia e hemicolectomia direita em monobloco para tratamento de câncer de cólon direito localmente avançado

Henriques

Waisberg

Possendoro

et al. 2010

Rev. Col. Bras. Cir.

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ABSTRACT ABSTRACT ABSTRACTThis article reports the case of a patient whit a diagnosis of diarrhea and weight loss. Subsidiary exams showed ulcerovegetant lesion in the second duodenal portion and duodenocolic fistula. An exploratory laparotomy was performed and a neoplasic lesion in the hepatic angle of the colon was observed invading the second duodenal portion. The patient then underwent a cephalic gastroduodenopancreatectomy associated with en bloc right hemicolectomy and improved well in the postoperative period. Currently, 48 months after the surgery, he does not present any signs of the disease dissemination or recurrence. The consulted literature recommends that multivisceral resection must be considered if the patient is clinically able to undergo major surgery and does not present any signs of neoplasic dissemination, since the postoperative survival time is considerably longer in the resected group and some of these patients even achieve cure.

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Multivisceral resection of advanced colorectal carcinoma

Abstract: An identical surgical risk and survival rates for curative resection, equally as good as those seen with conventional, non-extended procedures, justify the liberal use of multivisceral resection in the surgical treatment of colorectal carcinomas directly invading neighbouring organs.

Cited by 110 publications

References 16 publications

Multivisceral resections for locally advanced colorectal cancer after preoperative treatment

Multivisceral resections for locally advanced colorectal cancer after preoperative treatment

En bloc pancreaticoduodenectomy and right hemicolectomy to treat locally advanced right colon cancer: report of three cases

Duodenopancreatectomia e hemicolectomia direita em monobloco para tratamento de câncer de cólon direito localmente avançado

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