Outcomes, safety and staging of multivisceral resection for locally advanced primary colorectal cancer

Abstract

Background Multivisceral resection is often required in the treatment of locally advanced colorectal cancer. Aims The present study provides an analysis of the perioperative and oncological outcomes of multivisceral resection for locally advanced primary colorectal cancer (clinically T4bNxM0). Methods Between January 2001 and December 2013, fifty-eight patients who underwent multivisceral resection for locally advanced colorectal cancers (clinically T4bNxM0) were retrieved from a retrospective database. Among these patients, we divided into two groups as follows: twenty-two patients met the criteria of presence of tumour cell in adhesion to a nearby organ or structures, as confirmed on microscopic examination after surgery (Group I) and thirty-six patients met the criteria of no tumour cell in adhesion to a nearby organ or structures after surgery (Group II). Results The actual distribution of stage after surgery was pathologically reported as follows: IIa (n= 21, 58.3 per cent), IIb (n= 2, 5.5 per cent), IIIb (n= 9, 25.0 per cent), and IIIc (n= 4, 11.2 per cent) in Group II (initial clinical T4bNxM0) and IVa (n= 21, 95.5 per cent), (n= 1, 4.5 per cent) in Group I. With a median follow-up of 47.7 months, the five-year overall survival rate for Group I and Group II was 38.0 per cent and 62.9 per cent, respectively (p= 0.100). The five-year disease free survival rate was 36.8 per cent (Group I) versus 61.9 per cent (Group II) (p= 0.200). The local recurrence rate was 4.5 per cent (Group I) versus 5.6 per cent (Group II) (p= 0.278). The mean length of patients' hospital stay was 18.1 days and 15.9 days (p= 0.049). The rate of morbidity was 10.3 per cent in Group I and 28.4 per cent in Group II (p= 0.204). Conclusion Based on the present data, multivisceral resection for locally advanced colorectal cancer (clinically T4b) has acceptable perioperative and oncologic outcomes and may be a feasible procedure.