Multivisceral resection of advanced colorectal carcinoma

In about 10% of patients with carcinoma of the colorectum, the tumour has already invaded contiguous organs or else inflammatory tumorous adhesions involving neighbouring structures are found. In such a situation, the question arises whether one should perform a multivisceral resection, the usefulness of which in terms of surgical risk and late oncological results have been investigated in the present study.

A total of 173 patients with colorectal carcinoma who underwent a multivisceral resection during the period between 1984 and 1995 are reported. Excluded from the study were patients with recurrent tumour or distant metastases.

In the majority of cases (63%), the primary tumour originated in the sigmoid colon or rectum. In 102 patients, only a single neighbouring organ was additionally involved, while the remaining patients had involvement of two or more contiguous organs. In 140 patients, the resection was curative, while in the remaining patients an R1/2 situation presented. In the curative group, tumour infiltration was confirmed histologically in 55% of the cases, while in the remaining patients a peritumourous adhesion had mimicked tumour invasion. Postoperative surgical complications occurred in only 1.4% of the interventions, a figure identical to the incidence of complications seen with conventional limited operations. The same applied to the postoperative 30-day mortality rate of 3.6%. The 5-year survival rate of the overall group of patients undergoing multivisceral resection was 42%, that of the subgroup undergoing curative surgery was 51%, and that of the subgroup receiving only palliative resection was 0%. Calculation of the stage-related 5-year survival rates for Union Internationale Contra la Cancrum stage-II and stage-III tumours revealed figures of 58% and 43%, respectively. After non-extended resection, the respective survival rates were identical (60% and 41%).

An identical surgical risk and survival rates for curative resection, equally as good as those seen with conventional, non-extended procedures, justify the liberal use of multivisceral resection in the surgical treatment of colorectal carcinomas directly invading neighbouring organs.