Results after multivisceral resections of locally advanced colorectal cancers: an analysis on clinical and pathological t4 tumors

Gezen, Cem; Kement, Metin; Altuntas, Yunus Emre; Okkabaz, Nuri; Şeker, Mesut; Vural, Selahattin; Gümüş, Mahmut; Öncel, Mustafa

doi:10.1186/1477-7819-10-39

Cited by 74 publications

(69 citation statements)

References 24 publications

(65 reference statements)

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“…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.…”

Section: Discussioncontrasting

confidence: 67%

“…Few series in the literature have reported the need for blood transfusion, and those that have did not evaluate the correlation with complications. In others studies, 68% of patients required blood transfusions in advanced colonic cancer 10, and 40% of rectal cancer patients required perioperative transfusions 14. Blood transfusion likely reflects the severity of the illness and the more involved nature of the surgery, rather than constituting a risk factor by itself.…”

Section: Discussionmentioning

confidence: 95%

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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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Section: Discussioncontrasting

confidence: 67%

Section: Discussionmentioning

confidence: 95%

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

Nahas

Ribeiro

et al. 2017

Clinics

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“…This finding is similar to previous reports (5,6). On the other hand, some previous studies demonstrated that adhesions between tumor and other organs harbor malignant cells in 25-40% of cases, which are lower rates compared with our study (2,7,8). It is reported that the local recurrence rate was higher when adherent organs were dissected from the tumor than in cases in whom en bloc resection was performed (69 vs. 18%, respectively) (9).…”

Section: Discussionsupporting

confidence: 91%

“…As Nakafusa et al previously reported that only multivisceral resection was an independent factor for overall postoperative complications (14), extended en bloc multivisceral resection might involve serious complications, leading to an increase in morbidity and mortality. In previous reports, postoperative morbidity and mortality rates after mutivisceral resection tend to be higher ranging from 28.0 to 43.7% (2,8,12,(15)(16)(17) and ≥13% (5,7,12,18), respectively. We observed a postoperative mortality of 4.3% and a morbidity of 39.1% in our study.…”

Section: Discussionmentioning

confidence: 84%

Multivisceral resections for locally advanced colorectal cancer after preoperative treatment

et al. 2018

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Abstract. Multivisceral resection for colorectal cancer invading into the adjacent organs may often be difficult and may involve serious complications. Preoperative therapy may facilitate resection with safe margins. Between August 2007 and July 2016, 23 patients with colorectal cancer invading into the adjacent organs treated with preoperative treatment (chemoradiotherpay, chemotherapy, radiotherapy) were retrospectively investigated. All 23 patients received surgery with curative intent. Four patients had distant metastases at the time of diagnosis. Two patients had distant metastasis after preoperative treatment. The mean operative time was 535.3±185.5 min and the median amount of blood loss was 1,050 ml. Histopathological examination revealed malignant infiltration of the adjacent organs in 14 patients (60.9%). R0 resection rate was 73.9%. Postoperative complications were identified in nine patients (39.1%) and a high incidence of infectious complications was observed. Patients with curative resection showed a significantly better survival than patients with R1 or R2 resection (P<0.01). Multivisceral resection for locally advanced colorectal cancer invading into the adjacent organ after preoperative treatment may be performed with acceptable morbidity and minimal mortality. R0 resection improves the prognosis of patients with locally advanced colorectal cancer invading into the adjacent organ after preoperative treatment.

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“…In addition, reversal of loop ileostomy is safe and is shown to be associated with a mortality rate as low as 0.4 % [23]. Unfortunately, some ‘temporary’ stomas cannot be closed, and some of the studies analyzing the risk factors for the failure of stoma closure have some methodical problems mostly due to the heterogeneity of the information [91011121314].…”

Section: Discussionmentioning

confidence: 99%

Fortune of temporary ileostomies in patients treated with laparoscopic low anterior resection for rectal cancer

et al. 2017

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PurposeThe current study aims to analyze the risk factors for the failure of ileostomy reversal after laparoscopic low anterior resection for rectal cancer.MethodsAll patients who underwent a laparoscopic low anterior resection for rectal cancer with a diverting ileostomy between 2007 and 2014 were abstracted. The patients who underwent and did not undergo a diverting ileostomy procedure were compared regarding patient, tumor, treatment related parameters, and survival.ResultsAmong 160 (103 males [64.4%], mean [± standard deviation] age was 58.1 ± 11.9 years) patients, stoma reversal was achieved in 136 cases (85%). Anastomotic stricture (n = 13, 52.4%) was the most common reason for stoma reversal. These were the risk factors for the failure of stoma reversal: Male sex (P = 0.035), having complications (P = 0.01), particularly an anastomotic leak (P < 0.001), or surgical site infection (P = 0.019) especially evisceration (P = 0.011), requirement for reoperation (P = 0.003) and longer hospital stay (P = 0.004). Multivariate analysis revealed that male sex (odds ratio [OR], 7.82; P = 0.022) and additional organ resection (OR, 6.71; P = 0.027) were the risk factors. Five-year survival rates were similar (P = 0.143).ConclusionFifteen percent of patients cannot receive a stoma reversal after laparoscopic low anterior resection for rectal cancer. Anastomotic stricture is the most common reason for the failure of stoma takedown. Having complications, particularly an anastomotic leak and the necessity of reoperation, limits the stoma closure rate. Male sex and additional organ resection are the risk factors for the failure in multivariate analyses. These patients require a longer hospitalization period, but have similar survival rates as those who receive stoma closure procedure.

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Results after multivisceral resections of locally advanced colorectal cancers: an analysis on clinical and pathological t4 tumors

Cited by 74 publications

References 24 publications

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

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

Multivisceral resections for locally advanced colorectal cancer after preoperative treatment

Fortune of temporary ileostomies in patients treated with laparoscopic low anterior resection for rectal cancer

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