BackgroundManagement of locally advanced colon cancer (LACC) is challenging. Surgery is the mainstay of the treatment, yet its outcomes remain unclear, especially in the setting of multivisceral resections. The aim of the study was to examine the outcomes of standard and multivisceral colectomy in patients with LACC.Patients and methodsPatients demographics, clinical and perioperative data of patients operated within study period 2004–2018 were collected. LACC was defined as stage T4 colon cancer including tumor invasion either through the visceral peritoneum or to the adjacent organs/structures. Accordingly, either standard or multivisceral colectomy (SC and MVC) was performed.ResultsTwo hundred and three patients underwent colectomy for LACC. Of those, 112 had SC (55.2%) and 91 (44.8%) had MVC. Severe morbidity and mortality rates were 5.9% and 2.5%, respectively. MVC was associated with an increased blood loss (200 ml vs. 100 ml, p = 0.01), blood transfusion (22% vs. 8.9%, p = 0.01), longer operative time (180 minutes vs. 140 minutes, p < 0.01) and postoperative hospital stay (11 days vs. 10 days, p < 0.01) compared with SC. The complication-associated parameters were similar. Male gender, presence of ≥ 3 comorbidities, tumor location in the left colon and perioperative blood transfusion were associated with complications in the univariable analysis. In the multivariable model, the presence of ≥ 3 comorbidities was the only independent predictor of complications.ConclusionsColectomy with or without multivisceral resection is a safe procedure in LACC. In experienced hands, the postoperative outcomes are similar for SC and MVC. Given the complexity of the latter, these procedures should be reserved to qualified expert centers.

Locally advanced colon cancer is associated with poor prognosis. The aim of this report was to examine the association between the lymph node status and prognosis of locally advanced colon cancer. Perioperative and oncologic outcomes were studied in patients who had undergone colectomy for colon cancer between June 2004 and December 2018. Locally advanced colon cancer was defined as stage T4a/T4b cancer. The long-term oncologic results were investigated in patients with non-metastatic locally advanced colon cancer. Of 195 patients operated for locally advanced colon cancer, 83 (42.6%), 43 (22.1%), and 69 (35.3%) had pN0, pN1, and pN2 disease, respectively. Preoperative serum levels of CEA and CA 19-9, as well as incidence of distant metastases were significantly higher in patients with pN2 compared to those with pN0 and pN1. In non-metastatic setting, a trend towards higher incidence of recurrence was observed in node-positive patients. Nodal stage was a significant predictor for survival in the univariable analysis but non-significant after adjusting for confounders. Subgroup analyses among the patients with T4a and T4b cancer did not demonstrate any association between the nodal stage and survival. Preoperative CA 19-9 > 37 U/ml and adjuvant chemotherapy were the only prognostic factors in T4a and T4b colon cancer, respectively. Although a trend towards higher incidence of recurrence was observed in node-positive locally advanced colon cancer, nodal stage was not associated with survival. Adjuvant chemotherapy should be strongly considered in T4b stage colon cancer.

Risk factors for disease recurrence following curative resection for locally advanced colon cancer (LACC) remain unclear as conflicting results have been reported in the literature. The aim of this study was to examine these factors in the setting of developing country’s health care system affected by limited accessibility to the multimodal cancer treatment. Patients who had undergone curative colon resection for LACC between 2004 and 2018 were included. Data were obtained from a prospectively maintained database. Factors associated with disease recurrence, types of recurrence and recurrence-free survival were studied. A total of 118 patients with LACC were operated within the study period. Median follow-up was 36 (2-147) months. Adjuvant therapy was used in 41 (34.7%) patients and 62 (52.5%) were diagnosed with recurrence. In the multivariable analysis, disease recurrence was associated with tumor and nodal stages, as well as with the lymph node yield. Local recurrence, distant metastases, and peritoneal carcinomatosis were observed in 8 (6.8%), 30 (25.4%), and 24 (20.3%) patients, respectively. Early recurrence was diagnosed in 27 (22.9%) cases with peritoneal carcinomatosis being its most common type. Preoperative serum CA 19–9 levels, tumor, and nodal stages were linked to recurrence-free survival in the univariable analysis. Only tumor stage remained such in the multivariable model. Our findings suggest that lymph node yield, tumor, and nodal stages are associated with recurrence following curative resection for LACC.