Gastrointestinal Oncology

Annals of Surgical Oncology

, Volume 15, Issue 7, pp 1923-1930

First online:

Predictors of Multivisceral Resection in Patients with Locally Advanced Colorectal Cancer

  • Anand GovindarajanAffiliated withSunnybrook Health Sciences Centre
  • , Novlette FraserAffiliated withSunnybrook Health Sciences Centre
  • , Vanessa CranfordAffiliated withMemorial University Health Sciences Centre
  • , Debrah WirtzfeldAffiliated withMemorial University Health Sciences Centre
  • , Steve GallingerAffiliated withMount Sinai Hospital
  • , Calvin H. L. LawAffiliated withSunnybrook Health Sciences Centre
  • , Andrew J. SmithAffiliated withSunnybrook Health Sciences Centre
  • , Anna R. GagliardiAffiliated withSunnybrook Health Sciences Centre Email author 

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Practice guidelines recommend en bloc multivisceral resection (MVR) for all involved organs in patients with locally advanced adherent colorectal cancer (LAACRC) to reduce local recurrence and improve survival. We found that MVR was performed in one-third of eligible American patients in the Surveillance, Epidemiology and End Results cancer registry but that study could not identify factors amenable to quality improvement. This study was conducted to examine rates, and predictors of MVR among Canadian patients with LAACRC.


Rates of MVR were examined by observational study. Eligible patients were aged 20–74 years who had surgery for nonmetastatic LAACRC from July 1997 to December 2000. Patient, tumor, surgeon, and hospital characteristics were extracted from medical records. Summary statistics were compared by type of surgery (MVR, partial MVR, standard resection). To identify factors associated with MVR we analyzed operative notes and transcripts from interviews with general surgeons using standard qualitative methods.


Factors associated with MVR included fewer years in practice, preoperative treatment planning, involvement of surgical consultants, and access to diagnostic imaging and systems to enable preoperative multidisciplinary planning. Judgments regarding the nature of peritumoral adhesions, resectability, and personal technical skill may mediate decision-making. Many surgeons would prefer to refer patients than undertake complicated, lengthy cases.


Further research is required to validate these findings in larger studies and among patients undergoing surgery for conditions other than LAACRC, and evaluate strategies to improve rates of MVR through enhanced individual awareness and system capacity.

Key Words

Colorectal neoplasms Multivisceral resection Decision-making Practice guideline adherence Continuing education Quality improvement