Surgical management of the urinary tract in patients with locally advanced colorectal cancer

Fujisawa, Masato; Nakamura, Takeshi; Ohno, Masakazu; Miyazaki, Jiro; Arakawa, Soichi; Haraguchi, Takahiro; Yamanaka, Nozomu; Yao, Akihisa; Matsumoto, Osamu; Kuroda, Yoshikazu; Kamidono, Sadao

doi:10.1016/s0090-4295(02)01987-8

Cited by 44 publications

(20 citation statements)

References 22 publications

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“…For example, Fujisawa et al [5] reported that the overall complication rate in patients who underwent cystectomy was signifi cantly higher than that in those who were treated by bladder-sparing surgery. Balbay et al [2] , however, showed a similar incidence of urological complications in patients who underwent total pelvic exenteration and those who underwent bladder-sparing surgery.…”

Section: Discussionmentioning

confidence: 99%

“…Involvement of the genitourinary organ by advanced non-urological cancer arising adjacent to the urological organs, such as bladder, ureter, prostate and seminal vesicle, is frequently observed; hence, the surgical approach to these advanced diseases requires management of the urinary tract [2,5,[7][8][9][10] . Recent advances in techniques for urinary reconstruction, particularly continent urinary diversion, have contributed to a decrease in the associated surgical morbidity and improvement in the quality of life (QoL) following surgery [11][12][13] , resulting in the enhanced importance of the role played by urologists in the surgical treatment of patients with locally advanced pelvic cancer originating in non-urological organs.…”

Section: Introductionmentioning

confidence: 99%

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Reconstruction of Urinary Tract Combined with Surgical Management of Locally Advanced Non-Urological Cancer Involving the Genitourinary Organs

et al. 2006

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Introduction: The objective of this study was to review our experience with urinary reconstruction in patients undergoing surgical management for locally advanced pelvic cancer, and to evaluate the role of urologists in these procedures. Materials and Methods: This study included a total of 37 patients undergoing some type of urinary reconstruction due to invasion of the urological organs by locally advanced pelvic cancers, including 17 rectal cancers, 9 cervical cancers, 4 sigmoid cancers, 4 retroperitoneal sarcomas, 2 ovarian cancers and 1 appendiceal cancer. Among these 37, 18 were recurrent cancers following initial surgery for primary tumors. The clinical outcomes of these approaches were retrospectively analyzed. Results: Of the 37 patients, 9 underwent cystectomy (group A) with the following urinary diversions: ileal neobladder in 3, ileal conduit in 5 and colon conduit in 1, and 12 underwent partial cystectomy (group B), among whom 11 received additional urinary reconstruction as follows: bladder flap repair in 5, psoas hitch in 2, ileal ureter in 2, bladder augmentation in 1 and ureteroureterostomy in 1, while the remaining 16 (group C), in whom complete bladder preservation was possible, underwent the following types of urinary reconstruction: bladder flap repair in 6, psoas hitch in 3, en bloc removal of the rectum with prostate in 3, ileal ureter in 2, and ureteroureterostomy in 2. There were 10 early urological complications, including leakage of urine in 7 and acute pyelonephritis in 3. As a late urological complication, hydronephrosis was observed in 8 patients, but ureteral stent was not required in any of these 8. There were no significant differences in the incidence of postoperative complications, the status of surgical margin and the survival among groups A–C. Conclusion: Our experience with extended surgical management of non-urological pelvic cancer with reconstruction of the urinary tract suggests that the urological portion of this procedure can be performed with acceptable morbidity, and that the role of the urological surgeon during this procedure is potentially important.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Reconstruction of Urinary Tract Combined with Surgical Management of Locally Advanced Non-Urological Cancer Involving the Genitourinary Organs

et al. 2006

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“…Even with this diligent follow-up, the postoperative urologic complication rate was similar to that reported in a larger series from the Memorial Sloan-Kettering Cancer Center, where the reported rate of significant urologic complications following TPE was 17%. 23 Patients with rectal carconima who require removal of the bladder have higher complication rates, as outlined by Fujisawa and colleagues, 30 whose patients underwent bladder-sparing surgery for locally advanced rectal carcinoma and had a postoperative morbidity of 10.5%; the rate increased to 58.3% if cystectomy was required.…”

Section: Researchmentioning

confidence: 99%

Total pelvic exenteration for rectal cancer: outcomes and prognostic factors

Domes

Colquhoun²,

Taylor³

et al. 2011

Can J Surg

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Background:To perform complete resection of locally advanced and recurrent rectal carcinoma, total pelvic exenteration (TPE) may be attempted. We identified disease-related outcomes and prognostic factors. Methods:We conducted a single-centre review of patients who underwent TPE for rectal carcinoma over a 10-year period. Results:We included 28 patients in our study. After a median follow-up of 35 months, 53.6% of patients were alive with no evidence of disease. The 3-year actuarial disease-free and overall survival rates were 52.2% and 75.1%, respectively. On univariate analysis, recurrent disease, preoperative body mass index greater than 30 and lymphatic invasion were poor prognostic factors for disease-free survival, and only lymphatic invasion predicted overall survival. Additionally, multivariate analysis identified lymphatic invasion as an independent poor prognostic factor for disease-free survival in this patient population with locally advanced and recurrent rectal carcinoma. Conclusion:Despite the significant morbidity, TPE can provide long-term survival in patients with rectal carcinoma. Additionally, lymphatic invasion on final pathology was an independent prognostic factor for disease-free survival.Contexte : Pour pratiquer une résection complète du cancer du rectum avancé au stade local et récidivant, on peut tenter une exentération pelvienne totale (EPT). Nous avons déterminé des résultats liés à la maladie et des facteurs de pronostic. Méthodes :Nous avons procédé à une étude unicentrique portant sur des patients qui ont subi une EPT pour un cancer du rectum au cours d'une période de 10 ans.

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“…After resection of the bladder, an ileal conduit is usually constructed as originally described by Bricker [49]. In a number of series with both locally invasive primary tumours and recurrences, the bladder was spared in a greater percentage of patients with sigmoid cancer than in those with rectal cancer [32,50]. Locally advanced rectal cancers invading adjacent pelvic organs and involving the pelvic floor often require pelvic exenteration with total extirpation of the whole bladder and rectum followed by the formation of a permanent colostomy and ileal conduit.…”

Section: T4 Rectalmentioning

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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Surgical management of the urinary tract in patients with locally advanced colorectal cancer

Cited by 44 publications

References 22 publications

Reconstruction of Urinary Tract Combined with Surgical Management of Locally Advanced Non-Urological Cancer Involving the Genitourinary Organs

Reconstruction of Urinary Tract Combined with Surgical Management of Locally Advanced Non-Urological Cancer Involving the Genitourinary Organs

Total pelvic exenteration for rectal cancer: outcomes and prognostic factors

Multivisceral Resection for T4 or Recurrent Colorectal Cancer

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