Annals of Coloproctology

Original Articles

Malignant disease,Prognosis and adjuvant therapy,Colorectal cancer

Feasibility and Outcomes of Multivisceral Resection in Locally Advanced Colorectal Cancer: Experience of a Tertiary Cancer Center in North-East India: Joydeep Purkayastha, Pritesh Rajeev Singh, Abhijit Talukdar, Gaurav Das, Jitin Yadav, Srinivas Bannoth; Ann Coloproctol. 2021;37(3):174-178. Published online July 3, 2020; DOI: https://doi.org/10.3393/ac.2020.06.03

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Purpose
Locally advanced colorectal cancer may require an en bloc resection of surrounding organs or structures to achieve complete tumor removal. This decision must weigh the risk of complications of multivisceral resection against the potential survival benefit. The purpose of this study is to review a single-center experience of feasibility of en bloc multivisceral resections for locally advanced colorectal carcinoma and to examine the effect of surgical experience on immediate outcome and rate of R0 resections.
Methods
This is a study of 27 patients who underwent multivisceral resection for locally advanced colorectal carcinoma which was performed at our institute from January 2016 to December 2019. Among the 27 patients aged between 21 and 76 years (mean age, 48.67±7.3 years), 13 were males and 14 were females. Overall 18 patients had primary colon carcinoma and 9 had primary rectal carcinoma. All rectal cancer patients received neoadjuvant chemoradiation. All patients underwent surgery with curative intent. All patients underwent open surgery of which 66.7% underwent colectomy, 14.8% underwent anterior resection, 11.1% underwent Miles procedure, and 7.4% underwent pelvic exenteration.
Results
The mean operative time was 268.14±72.2 minutes and the median amount of blood units transfused was 2.07 units. The mean hospital stay was 13.67±3.4 days. Histologically, 44.4% of patients had well-differentiated adenocarcinoma and 55.6% had moderately differentiated adenocarcinoma. The final histopathological examinatio n revealed malignant infiltration of the adjacent organs in 19/27 patients (70.4%). Pathological complete response was seen in 2 patients. R0 resection rate achieved was 96.3%. Lymph node metastasis was seen in 66.7% of patients with colon cancer and 11.1% with rectal cancer with overall mean number of harvested lymph nodes being 12.44±3.01. Postoperative complications were identified in 7 patients (25.9%), while mortality was seen in 2 (7.4%).
Conclusion
Multivisceral resection for advanced colorectal cancer invading into the adjacent organ may be performed with acceptable morbidity and mortality.

Citations

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En bloc Right Hemicolectomy with Pancreaticoduodenectomy for Advanced Ascending Colon Cancer
Hiroyuki Takeda, Tetsuo Ishizaki, Ryutaro Udo, Tomoya Tago, Kenta Kasahara, Junichi Mazaki, Keiichiro Inoue, Yuichi Nagakawa
Surgical Case Reports.2025; 11(1): n/a. CrossRef
Comparison of short- and long-term outcomes between laparoscopic and open multivisceral resection for clinical T4b colorectal cancer: A multicentre retrospective cohort study in China
Jinzhu Zhang, Jinfeng Sun, Junguang Liu, Shiwen Mei, Jichuan Quan, Gang Hu, Bo Li, Meng Zhuang, Xishan Wang, Jianqiang Tang
European Journal of Surgical Oncology.2024; 50(1): 107316. CrossRef
Analysis of Patient Outcomes following Curative R0 Multiorgan Resections for Locally Advanced Gastric Cancer: A Systematic Review and Meta-Analysis
Viorel Dejeu, Paula Dejeu, Anita Muresan, Paula Bradea, Danut Dejeu
Journal of Clinical Medicine.2024; 13(10): 3010. CrossRef
Prognostic stratification of patients with pT4bN0M0 colorectal cancer following multivisceral resection: a multi-institutional case series analysis
Jichuan Quan, Kai Zuo, Guoli Li, Junguang Liu, Shiwen Mei, Gang Hu, Wenlong Qiu, Meng Zhuang, Ling Meng, Xishan Wang, Hu Chang, Jianqiang Tang
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Advances in the Treatment of Colorectal Cancer with Peritoneal Metastases: A Focus on Cytoreductive Surgery and Hyperthermic Intraperitoneal Chemotherapy
Youngbae Jeon, Eun Jung Park
The Ewha Medical Journal.2023;[Epub] CrossRef
Low Anterior Resection Syndrome: Pathophysiology, Risk Factors, and Current Management
Seung Mi Yeo, Gyung Mo Son
The Ewha Medical Journal.2022;[Epub] CrossRef

Analysis of the Prognostic Effectiveness of a Multivisceral Resection for Locally Advanced Colorectal Cancer: Sejin Park, Yun Sik Lee; J Korean Soc Coloproctol. 2011;27(1):21-26. Published online February 28, 2011; DOI: https://doi.org/10.3393/jksc.2011.27.1.21

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Abstract PDF

Purpose

The aim of this study was to evaluate the prognostic effectiveness of multivisceral resections of organs involved by locally advanced colorectal cancer.

Methods

A retrospective study was performed to analyze the data collected for 266 patients who underwent a curative resection for pT3-pT4 colorectal cancer without distant metastasis from January 2000 to December 2007. Of these 266 patients, 54 patients had macroscopically direct invasion of adjacent organs and underwent a multivisceral resection. We evaluated the short-term and the long-term outcomes of a multiviceral resection relative to that of standard surgery.

Results

The most common location for the primary lesion was the rectum, followed by the right colon and the sigmoid colon. Among the combined resected organs, common organs were the small bowel, ovary, and bladder. In the multivisceral resection group, tumor infiltration was confirmed histologically in 44.4% of the cases while in the remaining patients, a peritumorous adhesion had mimicked tumor invasion. Postoperative complications occurred in 17.5% of the patients who underwent standard surgery vs. 35.2% of those who underwent a multivisceral resection (P < 0.0001). But the survival rate of patients after a multivisceral resection was similar to that of patients after standard surgery (5-year survival rates: 61% vs. 58%; P = 0.36).

Conclusion

For locally advanced colorectal cancer, multivisceral resection was associated with higher postoperative morbidity, but the long-term survival after a curative resection is similar to that after a standard resection. Thus, a multivisceral resection can be recommended for most patients of locally advanced colorectal cancer.

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Concomitant Adjacent Organ Resection in Locally Advanced Colon Cancer.: Cho, Sung Wook , Lee, Ryung Ah , Chung, Soon Sup , Kim, Kwang Ho; J Korean Soc Coloproctol. 2009;25(2):94-99.; DOI: https://doi.org/10.3393/jksc.2009.25.2.94

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Abstract PDF

PURPOSE
In locally advanced adherent colon cancer surgery, a mutivisceral resection is known to reduce local recurrence and improve survival. Practically, the benefit of using this procedure may outweigh the risk of associated morbidity, but the procedure may not be performed uniformly. We reviewed the results of multivisceral resections for locally advanced colon cancer. METHODS: From 2003 January to 2008 January, 476 colon cancer patients underwent surgery for locally advanced colon cancer in our hospital. Out of the 476 patients, 36 patients with pT3-pT4 who underwent any kind of adjacent organ resection other than a resection of the colon were reviewed retrospectively. RESULTS: Out of the 36 patients, 22 were male and 14 were female, and the mean age was 63.44+/-13.26 yr. The sigmoid colon was the most common location for the primary lesion, followed by the ascending colon, the transverse colon, and the cecum. Invaded organs were the abdominal or pelvic wall in 5 patients, the visceral organs in 26 patients, the retroperitoneum in 2 patients. All patients received an en-bloc resection of the invaded organs. Ten patients were stage II, 14 patients were stage III, and 12 patients were stage IV. Fifteen patients were disease free at the end of this study, local recurrence had occurred in 1 patient, 6 patients had an intraabdominal recurrence, and 2 patients had developed a distant metastasis. The overall complication rate was 28%. The 5-yr survival rate of each stage according to the surgical approach did not show any meaningful difference. CONCLUSION: A multivisceral en-bloc resection has been recommended for locally advanced adherent colon cancer patients. To improve the outcome, we suggest progressive surgical treatment in such patients.

Citations

Citations to this article as recorded by

Analysis of the Prognostic Effectiveness of a Multivisceral Resection for Locally Advanced Colorectal Cancer
Sejin Park, Yun Sik Lee
Journal of the Korean Society of Coloproctology.2011; 27(1): 21. CrossRef

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