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Extended resection for locally advanced colorectal carcinoma
S A Curley1, G W Carlson, C R Shumate
1Department of General Surgery, University of Texas M.D. Anderson Cancer Center, Houston 77030.
American Journal of Surgery
|June 1, 1992
Summary
Preoperative evaluation accurately detects genitourinary invasion in locally advanced colorectal cancer. Thorough assessment aids surgical planning, improving survival rates through extended resections.
Area of Science:
- Oncology
- Surgical Oncology
- Urology
Background:
- Locally advanced colorectal carcinoma can invade adjacent genitourinary structures.
- Preoperative symptoms may indicate genitourinary involvement, but asymptomatic invasion also occurs.
Purpose of the Study:
- To evaluate the diagnostic accuracy of preoperative imaging and clinical assessment for genitourinary invasion in colorectal cancer.
- To determine the impact of preoperative evaluation and surgical resection on patient survival.
Main Methods:
- Retrospective review of 101 patients with locally advanced colorectal carcinoma undergoing extended resection (1965-1989).
- Analysis of preoperative symptoms, intravenous pyelography, computerized tomographic scans, and cystoscopy findings.
- Correlation of resection margin status with survival outcomes.
Main Results:
- Genitourinary invasion was present in 93% of patients with preoperative symptoms and 51% without.
- Preoperative imaging correctly predicted invasion in 83-89% of cases.
- Negative resection margins correlated with a 5-year survival rate of 54%, while positive margins resulted in significantly shorter survival.
Conclusions:
- Thorough preoperative evaluation is crucial for identifying genitourinary invasion in advanced colorectal cancer.
- Accurate diagnostic assessment facilitates appropriate surgical planning for extended resection.
- Achieving tumor-negative resection margins through extended resection improves local control and long-term survival.