Multivisceral resection for primary locally advanced rectal carcinoma

Harris, Dean; Davies, Mark; Lucas, Malcolm G; Drew, Peter; Carr, Norman J.; Beynon, J.

doi:10.1002/bjs.7373

Cited by 68 publications

(85 citation statements)

References 23 publications

(25 reference statements)

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“…It is difficult to distinguish the benefits of preoperative chemoradiotherapy, however, in patients with adjacent organ invasion. The use of preoperative treatment may contribute to an improved R0 resection rate, as in a recent British study where 25 of 33 patients who had an R0 total pelvic exenteration (TPE) had received preoperative treatment [17]. Additional treatment modalities may become more widely used in the multimodality approach to recurrent colorectal cancer.…”

Section: Neoadjuvantmentioning

confidence: 97%

“…Intraoperatively differentiating malignant invasion from benign adhesion is often impossible and dissecting through a malignant fistula, thereby violating tumour planes, is associated with tumour dissemination and adverse outcome. Thus, en bloc resection of involved adjacent organs is required to avoid dissemination and positive resection margins [17]. Lehnert et al [21] found the intraoperative accuracy of predicting a potentially curative operation was similar for colon (86%) and rectal (84%) cancer, for an overall accuracy rate of 85%.…”

Section: Stagingmentioning

confidence: 99%

“…While infralevator pelvic exenteration is always required for a tumour involving the trigone or the prostate, supralevator exenteration with neobladder pouch formation [51,52] can be performed in selected cases to preserve the patient’s urinary continence [53,25]. Pelvic floor reconstruction can be achieved by a combination of pelvic omentoplasty, porcine dermal collagen implantation or myocutaneous flaps [17]. Ferenschild et al [54] described 48 patients with rectal cancer who underwent TPE: 32 primary and 16 recurrent.…”

Section: T4 Rectalmentioning

confidence: 99%

“…Local restaging by CT, MRI, endorectal ultrasonography and examination under anaesthesia is performed routinely after preoperative treatment to determine resectability in many institutions. Positron emission tomography (PET) is increasingly used and is of particular advantage in the diagnosis of metastases and locally recurrent disease [16,17]. …”

Section: Stagingmentioning

confidence: 99%

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Multivisceral Resection for T4 or Recurrent Colorectal Cancer

Larkin

O'Connell²

2012

Dig Dis

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Background: Approximately 10% of patients with colorectal cancer have locally advanced disease with peritoneal involvement (T4a) or invasion of adjacent organs (T4b) at the time of diagnosis. Of patients who undergo resection with curative intent, between 7 and 33% develop isolated locoregional recurrences. R0 surgical excision is potentially curative. Methods: We reviewed the literature relating to multivisceral resection for T4 or recurrent colorectal cancer. Results: Comprehensive staging to identify the local and systemic extent of disease is essential to determine resectability and patient suitability for a curative approach. PET scans and pelvic MRI (rectal) staging and a coordinated multispecialty input to neoadjuvant treatment, multivisceral surgical resection, reconstruction and adjuvant chemotherapy are essential. Intraoperative radiotherapy and hyperthermic intraperitoneal chemotherapy may have a role in selected patients. R0 resection can achieve 5-year local control rates for primary locally advanced and recurrent colorectal cancer of up to 89 and 38%, respectively, and overall 5-year survival up to 66 and 25%, respectively. Conclusion: An aggressive surgical strategy as part of a multimodal strategy in the treatment of locally advanced or recurrent colorectal cancer in the absence of incurable metastatic disease affords the best prospect for long-term survival in selected patients.

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Section: Neoadjuvantmentioning

confidence: 97%

Section: Stagingmentioning

confidence: 99%

Section: T4 Rectalmentioning

confidence: 99%

Section: Stagingmentioning

confidence: 99%

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Multivisceral Resection for T4 or Recurrent Colorectal Cancer

Larkin

O'Connell²

2012

Dig Dis

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“…Thus, treatment guidelines recommend multivisceral en bloc resection (MVEBR) for the treatment of clinically T4b tumors, as most studies have shown that MVEBR improves the rate of R0 resection, which is associated with better local control and overall survival 2,3. Neoadjuvant treatment (especially for rectal cancers) and complete resection, including en bloc resection of affected adjacent organs, is the standard clinical recommendation for patients with CRC.…”

Section: Introductionmentioning

confidence: 99%

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

Nahas

Ribeiro

et al. 2017

Clinics

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OBJECTIVES:This study sought to determine the clinical and pathological factors associated with perioperative morbidity, mortality and oncological outcomes after multivisceral en bloc resection in patients with colorectal cancer.METHODS:Between January 2009 and February 2014, 105 patients with primary colorectal cancer selected for multivisceral resection were identified from a prospective database. Clinical and pathological factors, perioperative morbidity and mortality and outcomes were obtained from medical records. Estimated local recurrence and overall survival were compared using the log-rank method, and Cox regression analysis was used to determine the independence of the studied parameters. ClinicalTrials.gov: NCT02859155.RESULTS:The median age of the patients was 60 (range 23-86) years, 66.7% were female, 80% of tumors were located in the rectum, 11.4% had stage-IV disease, and 54.3% received neoadjuvant chemoradiotherapy. The organs most frequently resected were ovaries and annexes (37%). Additionally, 30.5% of patients received abdominoperineal resection. Invasion of other organs was confirmed histologically in 53.5% of patients, and R0 resection was obtained in 72% of patients. The overall morbidity rate of patients in this study was 37.1%. Ureter resection and intraoperative blood transfusion were independently associated with an increased number of complications. The 30-day postoperative mortality rate was 1.9%. After 27 (range 5-57) months of follow-up, the mortality and local recurrence rates were 23% and 15%, respectively. Positive margins were associated with a higher recurrence rate. Positive margins, lymph node involvement, stage III/IV disease, and stage IV disease alone were associated with lower overall survival rates. On multivariate analysis, the only factor associated with reduced survival was lymph node involvement.CONCLUSIONS:Multivisceral en bloc resection for primary colorectal cancer can be performed with acceptable rates of morbidity and mortality and may lead to favorable oncological outcomes.

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