Surgical approach in locally advanced colorectal cancer--combined, extended and compound surgery

Cancer of the colon and rectum (colorectal cancer - CRC) is ranked second in prevalence--the men he is after lung cancer, and for women--after breast cancer. There is a steady trend to annual increase in incidence in the country. Definition of locally advanced disease is necessary in order to achieve practical and theoretical clarity regarding not a small percentage of patients with colorectal cancer presenting for treatment to the surgeon. As for the primary and the recurrent locally advanced tumors, postoperative long-term survival is achievable, but only after complete R0-resection.

The objective of the presented literature review is to analyze data from a number of internationally published studies looking multifactorial variety of problems in the primary and recurrent locally advanced colorectal cancer (LAKRK) capable of optimizing behavior in surgical patients with this frequently encountered oncological and social significant pathology. Aim The objective of the presented literature review is to analyze data from a number of internationally published studies looking multifactor variety of problems in the primary and recurrent locally advanced colorectal cancer (LACRC) capable of optimizing behavior in surgical patients with this frequently encountered oncologic and social significant pathology.

A retrospective, critical and comparatively examined published in the world literature review papers, case reports and clinical studies dealing with locally advanced primary and recurrent cancer that goes beyond the colon and rectum involving the surrounding structures and organs with the requirements for individualized "Team" approach of preoperative and intraoperative staging, planning and execution of multivisceral "en-block" resection with typical technical difficulties, complications and results.

As "locally advanced" tumors represent 5-22% of all colorectal carcinomas. According to the analyzed data in patients with tumor stage IIB, which extend through the intestinal wall and infiltrated the surrounding structures without lymph node metastases (T4 N0 M0) have a worse chance of survival than those with tumors in stage III, which remain within the intestinal wall, but had spread to the lymph nodes (T1 - 2 N1 - 2). Recent studies confirm that T4 stage is an important independent predictor of disease-free interval and overall survival. Discussed are the terms " combined", "extended" and "compound" surgery. Describe the importance of dissection in lymphnodes in LACRC through related analogue of total mesorectal excision in rectal cancer excision in complete mesocolic excision location in the colon. Discussed are ways of locally advanced primary tumors and recurrences with different types of loco - regional involvement of surrounding structures and organs. Describe in detail the operational- tactical and technical aspects of the block R0- resection in primary and recurrent LAKRK with type and severity of any complications and treatment outcomes. Concerns the importance of an integrated approach with neoadjuvant and adjuvant chemotherapy and radiotherapy.

Justified the opinion of the adequate, in particular disease, reasonably aggressive pattern to LACRC securing the most favorable long-term survival prognosis.