Surgical Treatment of Locally Advanced Rectal Cancer

Abstract

Aims: The results of surgical treatment of locally advanced rectal cancer with special regard to multivisceral resections and preoperative radiotherapy should be analyzed. Methods: From 10/86 until 12/95, 40 patients with preoperatively assessed T4 stage rectal cancer were treated in our department whose data were evaluated retrospectively. Results: Apart from 10 nonresecting procedures we performed 30 resections in which the mortality rate was 7%. In 50% of these patients a multivisceral resection was conducted. A R0 situation could be achieved in 70%. But only in 53% the operation was carried out with curative approach due to distant metastasis. After extended resections more frequent urological complications resulted in prolonged hospitalization. Survival time was markedly longer in patients without tumor residuals or metastasis. Following preoperative radiotherapy a higher number in tumor free patients and better prognosis was noticed. Conclusions: In accordance to the literature it is suggested to submit patients with T4-stage rectal cancer to preoperative radiation to improve the overall outcome.

Comparison of Multivisceral Resection and Standard Operation for Locally Advanced Colorectal Cancer: Analysis of Prognostic Factors for Short-Term and Long-Term Outcome

“…28 The average rate of pathologic invasion to the organs of combined resection was 54 percent, with a range of 25 percent to 84 percent in patients who had received multivisceral resection for colorectal cancer in the previous series. [2][3][4][5][6][7][8][9][10][11][12][13][14][15][16][17] The local recurrence rate was much higher when adherent organs were separated from the tumor than when en bloc resection was performed (69 percent vs. 18 percent). 7 The five-year survival rate was 17 percent after inadvertent dissection or rupturing of the tumor, compared with 49 percent after en bloc resection.…”

“…[Key words: Multivisceral resection; Colorectal cancer; Postoperative complication; Morbidity and mortality; Prognostic factors; Blood transfusion] M ultivisceral resection is sometimes required to cure locally advanced colorectal cancer. 1 Many investigators [2][3][4][5][6][7][8][9][10][11][12][13][14][15][16][17] have reported that multivisceral resection for colorectal cancer has shown acceptable morbidity and mortality rates and has a fair long-term prognosis, and have thus emphasized the benefits of this procedure. However, it is also well recognized that a highly extended operation increases morbidity and mortality.…”

“…18,19 The difference in opinion between these studies may lie in the fact that most of the previous reports analyzed the outcome of only those patients who had received multivisceral resection for colorectal cancer, especially the shortterm outcome. [2][3][4][5][6][7][8][9][10][11][12][13][14][15][16][17][18][19] We evaluated the short-term and long-term outcome of multivisceral resection for colorectal cancer relative to outcomes of the standard operation. Following this evaluation, factors associated with multivisceral resection and the contribution of these factors to outcome were analyzed to clarify the characteristics of multivisceral resection.…”

Locally advanced colorectal cancer: results of surgical treatment and prognostic factors

“…Such a situation may demand different operative strategies and technical skills from the surgical team (2,17) . Within this context, a proper oncologic approach includes an en-bloc multivisceral resection of all organs and/or structures involved.…”

T4-Rektumkarzinom Operative und multimodale Therapie

“…Mit diesem Ziel konnte die Resektionsrate bei primär nicht resektablen Rektumkarzinomen nach kombinierter präoperativer Radiochemotherapie auf bis zu 90% angehoben werden, ohne hierbei die perioperative Morbidität wesentlich zu erhöhen [1,13,24].…”