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

Abstract

-Objectives -To evaluate the incidence surgical results and prognostic factors of locally advanced colorectal cancer.Methods -Cohort study including 679 colorectal cancer patients treated from 1997 to 2007. Clinical, surgical and histological data were analyzed. Results -Ninety patients (females 61%; median age 59 years) were treated for locally advanced carcinomas (13.2%), either in the colon (66%) or rectum (34%). Extended resections most commonly involved the small bowel (19.8%), bladder (16.4%), uterus (12.9%) and ovaries (11.2%). Postoperative morbidity and mortality occurred in 23 (25.6%) and 3 (3.3%) patients, respectively. Survival and recurrence analysis among 76 R0 (84.4%) procedures revealed a 60% 5-year survival and 34% local recurrence rates. Survival curves demonstrated reduced rates for rectal location (45% vs 65%), tumor depth (50% for T4 vs 75% for T3), vascular/ lymphatic/perineural invasion (35% vs 80%) and lymph node metastasis (35% vs 80%). Conclusions -Locally advanced carcinomas were found in 13.2% of patients. Survival rates were negatively affected by rectal location and adverse histological features. Number of involved organs and neoplastic adhesions did not influenced chances of survival. A radical R0 extended resection was achieved in a high proportion of cases, resulting in a 60% cancer-free survival under acceptable operative risks. HEADINGS -Colorectal neoplasms, surgery.

Prognostic factors affecting outcomes in multivisceral en bloc resection for colorectal cancer

“…Metastatic patients were present in fewer than 20% of these series. The overall morbidity rate in this study was 37.1%, which is concordant with the results of other series (range 24-50%) 3,9-13. However, it is important to state that only 10% of patients in this study required surgical or image-guided intervention for these complications.…”

“…However, the two series with predominantly male patients reported morbidity rates of 24% and 50% 3,10. These results were not significantly different from those of studies not composed predominantly of male patients, such as the current study (morbidity ranged from 25-48%) 9,11-13.…”

“…A series of 42 MVEBR procedures for rectal cancer reported that patients stayed a mean of 16 days, which is longer than that reported in this series 3. However, this information was not routinely reported in the other studies 5,9.…”

Current issues on the understanding of locally advanced colorectal cancer

“…Inclusion of clinical, surgical and pathological data capable of affecting survival suggested the role of several factors potentially implicated in oncological outcomes of these patients. Of note is the absence of influence of actual neoplastic adjacent organ invasion when compared to inflammatory adhesions in the study reported by Campos et al (2) . The most recent edition of the AJCC TNM classification system suggests subdivision T4 colorectal cancer that should definitively be considered in future studies.…”

“…In the current issue of ARQUIVOS de GASTROENTEROLOGIA, a very interesting study on prognostic factors after radical surgery for locally advanced colorectal cancer by Campos et al (2) , brings up a series of aspects relevant to the current literature that deserve consideration.…”