[Multiorgan surgery in rectal cancer--extended therapy or improvement of prognosis?]

About 10% of rectal cancers have to be treated by a multivisceral resection. Within a period of 14 years we performed 103 of these operations, 60 for primary cancers, 43 for recurrent cancers with a significant increase in the latter. The total or partial removal of 204 extra-rectal organs allowed for a R0 resection in 67% of cases. 69% were confirmed as being pT4 by histologic examination. In comparison with conventional rectal resection morbidity is higher at 32% while mortality is identical with 4%. A significant benefit (p < 0.05) in terms of survival is found for primary cancers as opposed to recurrences, R0 resections compared to R1 or R2 resections, lymphnode negative compared to lymphnode positive patients and patients who underwent IORT. The number of additionally removed organs did not influence survival. Compared with the natural course even palliative resections carry a survival benefit and allow the treatment of the often devastating specific morbidity of the disease. Despite adjuvant multimodal therapies the high rate of local and distant recurrences after multivisceral resection of the rectum still poses a major problem.