Colon Cancer: Multivisceral Resection

Abstract

Up to 10% of primary colon cancers are attached to adjacent organs or other anatomical structures. True invasion, however, occurs in approximately 50%, with the remaining cases secondary to adhesions from tumour-related inflammation and contained tumour perforation. The most commonly involved organs and structures include small bowel, urinary bladder and abdominal wall. The sigmoid colon is the most common primary tumour site with advanced disease [1]. Organs less commonly involved with locally invasive colon cancer are the liver, spleen, pancreas, stomach and gallbladder. Nevertheless, when a structure in the abdomen is involved with the primary tumour, regardless of the anatomical site, it must be included en bloc with the primary specimen. Attempts to “reduce” radicality by shaving off adherent structures from the primary tumour are likely to result in a palliative situation. Situations involving an R1 (microscopically positive margins) resection, even when subsequent resection is planned, are associated with significantly higher risks of local recurrence including peritoneal carcinomatosis. Local residual cancer (R1, 2 resection) is a significant predictor of survival, with a median survival of 12 months [2–4]. This applies not only to local recurrence but also to distant metastases [5].