Multivisceral resections for colorectal cancer

López, Marvin J.

doi:10.1002/1096-9098(200101)76:1<1::aid-jso1000>3.0.co;2-q

Cited by 31 publications

(30 citation statements)

References 18 publications

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“…After complete en bloc resection, the 5-year survival rate was 30-57% and it decreased for the cancers involving carcinomatous adhesions. In a review study of multivisceral colorectal cancer in 2001, Marvin reported the cumulative 5-year survival rate of 68% for IA and 40% for MI [4]. The more recent studies reported that in the event of local involvement of urinary bladder in colorectal cancer following en bloc resection, 5-year survival was significantly better for patients with IA than for patients with MI (58 vs 41%, P = 0.041); and in R0 resection, lymph node status was the most important factor that related significantly to the survival by multivariate analysis [13,21,22].…”

Section: Discussionmentioning

confidence: 99%

“…Among 153,760 new cases of colorectal cancer diagnosed annually in the USA [1], approximately 5-15% will have macroscopic involvement of contiguous organs, and this proportion has changed a little in half a century [2][3][4][5][6]. Many of these locally advanced lesions, despite their large size, directly invade adjacent organ structures and there is no evidence of distant metastases (DM) [7,8].…”

Section: Introductionmentioning

confidence: 99%

“…These guidelines are based on studies that have demonstrated that 40-84% of adhesions between the cancer and the adjacent organs are malignant [11][12][13] and that intraoperative assessments of the nature of adhesions are often inaccurate. Among patients with locally advanced adherent colorectal cancer, MVR results in the improved rates of marginnegative (R0) resections, local control, and overall survival [4,[13][14][15][16].…”

Section: Introductionmentioning

confidence: 99%

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Adhesion Pattern and Prognosis Studies of T4N0M0 Colorectal Cancer Following En Bloc Multivisceral Resection: Evaluation of T4 Subclassification

Chen

Liu

Jiang

et al. 2010

Cell Biochem Biophys

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In current TNM stage system, T4 lesions represent a complex group and should be considered to further optimize the classification. This study evaluates the significance of adhesion pattern in T4 subclassification based on prognostic analysis of T4N0M0 colorectal cancer following en bloc multivisceral resection (MVR). Prospectively collected data (1992-2004) were analyzed for 278 patients with stage T4N0M0 lesions following MVR for colorectal cancer. Patients were divided into inflammatory adhesion (IA) and malignant invasion (MI) groups based on adhesion to adjacent organs. Survival was evaluated by Kaplan-Meier and Cox proportional hazards regression analyses. MI was detected in 249 of 460 (54.1%) resected organs and in 159 of 287 (55.40%) patients undergoing MVR. Compared with IA group, patients in MI group showed no significant difference in clinicopathological data except tumor differentiation (P = 0.0376). Cox proportional hazards regression showed that MI was independently associated with overall survival among both colon (HR = 2.028; P = 0.0001) and rectal (HR = 0.451; P = 0.0002) cancer patients. Kaplan-Meier analysis showed that MI patients had a significantly higher MVR compared with IA patients (colon cancer: P = 0.0018; rectal cancer: P = 0.0116). In conclusion, MI was validated as an adverse prognostic factor for stage T4N0M0 colorectal cancer following MVR suggesting that it may be classified as a T4-subgroup in order to reinforce practice guidelines.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Adhesion Pattern and Prognosis Studies of T4N0M0 Colorectal Cancer Following En Bloc Multivisceral Resection: Evaluation of T4 Subclassification

Chen

Liu

Jiang

et al. 2010

Cell Biochem Biophys

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“…This trend has been demonstrated in the attention given to quality assurance in surgery and pathology in the performance of sentinel node biopsy for breast cancer and melanoma, and in the literature concerning the treatment of colorectal cancer [7,8]. If a surgeon can be a prognostic factor in the outcome of a disease, could he or she be a prognostic factor in outcomes related to quality of life?…”

Section: Introductionmentioning

confidence: 99%

Surgical palliation in advanced disease: Recent developments

Dunn

2002

Curr Oncol Rep

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Despite many valuable technical innovations for the relief of suffering in advanced disease over the past few years, only recently have surgical oncologists attempted to more clearly define palliation. Previous definitions have been misleading, creating confusion about the merits of surgery in many situations and difficulty in posing questions for future prospective clinical trials. This report outlines recent progress in identifying and refining a philosophy of palliative surgery that would align it with the consensus of nonsurgical opinion summarized by the 1990 World Health Organization definition of palliative care and the emerging consensus among the medical specialties in the United States concerning principles of care at the end of life. Selected controversies and recent innovations, as well as guidelines for palliative surgery, are discussed.

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“…In up to 15% of cases, the primary tumor is adherent to adjacent organs as a result of direct malignant invasion or peritumoral inflammatory reaction. Intraoperative assessment of adhesions as malignant or benign has often been debated [1,2]. …”

Section: Introductionmentioning

confidence: 99%

Multivisceral resection for locally advanced rectal cancer: adequate length of distal resection margin

Kang

Kim

et al. 2012

J Korean Surg Soc

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PurposeLocally advanced rectal cancer may require an intraoperative decision regarding curative multivisceral resection (MVR) of adjacent organs. In bulky tumor cases, ensuring sufficient distal resection margin (DRM) for achievement of oncologic safety is very difficult. This study is designed to evaluate the adequate length of DRM in multiviscerally resected rectal cancer.MethodsA total of 324 patients who underwent curative low anterior resection for primary pT3-4 rectal cancer between 1995 and 2004 were identified from a prospectively collected colorectal database.ResultsShort lengths of DRM (≤1 cm) did not compromise essentially poor oncologic outcomes in locally advanced rectal cancer (P = 0.736). However, especially in rectal cancers invading adjacent organs, DRM of less than 2 cm showed poor survival outcome. In 5-year and 10-year survival analysis of MVR, a shorter DRM (<2 cm) showed 41.9% and 30.5%, although a longer DRM (≥2 cm) showed 72.4% and 60.2% (P = 0.03, 0.044). In multivariate analysis of MVR, poorly differentiated histology, ulceroinfiltrative growth of tumor, and short DRM (<2 cm) were significant factors for prediction of poor survival outcome, although short DRM was not significantly related to local and systemic recurrence.ConclusionIn locally advanced rectal cancer of pT3-4, a short length of DRM (≤1 cm) did not compromise essentially poor oncologic outcome. In rectal cancers invading adjacent organs and requiring MVR, a shorter DRM (<2 cm) was found to be related to poor survival outcome.

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Multivisceral resections for colorectal cancer

Cited by 31 publications

References 18 publications

Adhesion Pattern and Prognosis Studies of T4N0M0 Colorectal Cancer Following En Bloc Multivisceral Resection: Evaluation of T4 Subclassification

Adhesion Pattern and Prognosis Studies of T4N0M0 Colorectal Cancer Following En Bloc Multivisceral Resection: Evaluation of T4 Subclassification

Surgical palliation in advanced disease: Recent developments

Multivisceral resection for locally advanced rectal cancer: adequate length of distal resection margin

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