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Extended resection for locally advanced colorectal carcinoma
1Department of Surgery, Kaiser Permanente Medical Group, Los Angeles, California 90027, USA.
Annals of Surgical Oncology
|March 1, 1997
Summary
Multivisceral resection (MVR) for advanced colorectal cancer shows promising survival benefits, especially for inflammatory adhesions. Aggressive surgical approaches are warranted despite no significant difference in survival rates with multiple organ resections.
Area of Science:
- Oncology
- Surgical Oncology
- Gastrointestinal Surgery
Background:
- Locally advanced colorectal carcinomas present complex surgical challenges.
- Multivisceral resection (MVR) is a strategy for tumors involving adjacent structures.
- Understanding the therapeutic benefit of MVR is crucial for treatment planning.
Purpose of the Study:
- To evaluate the therapeutic benefit of multivisceral resection (MVR) in patients with locally advanced colorectal carcinomas.
- To assess the impact of resecting adhesed adjacent secondary organs or structures (ASOS) on survival outcomes.
Main Methods:
- A cohort of 118 patients with locally advanced colorectal carcinomas undergoing MVR was analyzed.
- Tumors were staged as B3 (T4,N0) and C3 (T4,N1-3).
- Adhesions were classified as invasive (B3+,C3+) or inflammatory (B3-, C3-).
Main Results:
- Five-year survival rates were 62% for B3 and 38% for C3 lesions (p=0.017).
- Patients with inflammatory adhesions (B3-, C3-) had higher 5-year survival (71%) compared to invasive adhesions (B3+/C3+, 47%, p=NS).
- Resection of one, two, or three/four ASOS showed similar 5-year survival rates (52%, 55%, 38%, respectively, p=NS).
Conclusions:
- MVR is a viable approach for locally advanced colorectal cancer.
- Surgical strategy should consider the nature of adhesions, favoring resection in inflammatory cases.
- An aggressive surgical approach is supported, as survival is not significantly compromised by resecting multiple ASOS.