Abstract
Purpose
The current study was designed to identify prognostic factors for long-term survival in patients with advanced colorectal cancer in a consecutive cohort.
Methods
A total of 123 patients were operated because of T4 colorectal cancer between 1 January 2002 and 31 December 2008 in the Clinic of Surgery, UK-SH Campus Luebeck.
Results
A total of 78 patients underwent a multivisceral resection. The postoperative morbidity was elevated in the patient group with multivisceral resections (34.6% vs. 26.7%). Nevertheless, we detected no significant differences concerning 30 days mortality (7.7% vs. 8.9%; p = 0.815). The main prognostic factor that reached significance in the multivariate analysis was the possibility to obtain a R0 resection (p < 0.0001) resulting in a 5-year survival rate of 55% for patients with curative resection. There were no statistically significant differences in 5-year survival between multivisceral and non-multivisceral resections (p = 0.608). Also we were not able to detect any significant differences for cancer of colonic or rectal origin (p = 0.839), for laparoscopic vs. open procedures (p = 0.610), and for emergency vs. planned operations (p = 0.674). Moreover, the existence of lymph node metastases was not a predictive factor concerning survival as there was no difference between patients with and without lymph node metastases (p = 0.658).
Conclusions
Multivisceral resections are associated with the same 5-year survival as standard resections. Therefore, the aim to perform a R0 resection should always be the main goal in surgery for colorectal cancer. In planned operations, a laparoscopic approach is justified in selected patients.
This is a preview of subscription content, log in via an institution to check access.
Similar content being viewed by others
References
Brenner H, Bouvier AM, Foschi R, Hackl M, Larsen IK, Lemmens V, Mangone L, Francisci S (2011) Progress in colorectal cancer survival in Europe, from the late 1980s to the early 21st century: The EUROCARE study. Int J Cancer. doi:10.1002/ijc.26192
Gebhardt C, Meyer W, Ruckriegel S, Meier U (1999) Multivisceral resection of advanced colorectal carcinoma. Langenbeck’s Arch Surg 384:194–199
Lehnert T, Methner M, Pollok A, Schaible A, Hinz U, Herfarth C (2002) Multivisceral resection for locally advanced primary colon and rectal cancer. An analysis of prognostic factors in 201 patients. Ann Surg 235:217–225
Nakafusa Y, Tanaka T, Tanaka M, Kitajima Y, Sato S, Miyazaki K (2004) Comparison of multivisceral resection and standard operation for locally advanced colorectal cancer: analysis of prognostic factors for short-term and long-term outcome. Dis Colon Rectum 47:2055–2063
Croner RS, Merkel S, Papadopoulos T, Schellerer V, Hohenberger W, Goehl J (2009) Multivisceral resection for colon carcinoma. Dis Colon Rectum 52(8):1381–1386
Eisenberg SB, Kraybill WG, Lopez MJ (1990) Long-term results of surgical resection of locally advanced colorectal cancer. Surgery 108:779–786
Hermanek P (1999) Prognostic factor research in oncology. J Clin Epidemiol 52:371–374
Radespiel-Troeger M, Hohenberger W, Reingruber B (2004) Improved prediction of recurrence after curative resection of colon carcinoma using tree-based risk stratification. Cancer 100:958–967
Tsai HL, Lu CY, Hsieh JS, Wu DC, Jan CM, Chai CY, Chu KS, Chan HM, Wang JY (2007) The prognostic significance of total lymph node harvest in patients with T2-4N0M0 colorectal cancer. J Gastrointest Surg 11(5):660–665
Sjo OH, Larsen S, Lunde OC, Nesbakken A (2009) Short term outcome after emergency and elective surgery for colon cancer. Colorectal Dis 11(7):733–739
Hunter JA, Ryan JA, Schultz P (1987) En bloc resection of colon cancer adherent to other organs. Am J Surg 145:67–71
Gall FP, Tonak J, Altendorf A (1987) Multivisceral resections in colorectal cancer. Dis Colon Rectum 30:337–341
Kruschewski M, Pohlen U, Hotz HG, Ritz JP, Kroesen AJ, Buhr HJ (2006) Results of multivisceral resection of primary colorectal cancer. Zentralbl Chir 131:217–222
Bokey EL, Chapuis PH, Fung C (1995) Postoperative morbidity and mortality following resection of the colon and rectum for cancer. Dis Colon Rectum 38:480–487
Anderson JH, Hole D, McArdle CS (1992) Elective versus emergency surgery for patients with colorectal cancer. Br J Surg 89:1557–1562
Merkel S, Meyer C, Papadopoulos T, Meyer T, Hohenberger W (2007) Urgent surgery in colon carcinoma. Zentralbl Chir 132:16–25
Andreoni B, Chiappa A, Bertani E, Bellomi M, Orecchia R, Zampino M, Fazio N, Venturino M, Orsi F, Sonzogni A, Pace U, Monfardini L (2007) Surgical outcomes for colon and rectal cancer over a decade: results from a consecutive monocentric experience in 902 unselected patients. World J Surg Oncol 5:73
Darakhshan A, Lin BPFC, Chan C, Chapuis PH, Dent OF, Bokey L (2008) Correlates and outcomes of tumor adherence in resected colonic and rectal cancers. Ann Surg 247:650–658
Kuhry E, Schwenk WF, Gaupset R, Romild U, Bonjer HJ (2008) Long-term results of laparoscopic colorectal cancer resection. Cochrane Database Syst Rev 2:CD003432
Bretagnol F, Dedieu A, Zappa M, Guedj N, Ferron M, Panis Y (2011) T4 colorectal cancer: is laparoscopic resection contraindicated? Colorectal Dis 13(2):138–143
Hemandas AK, Abdelrahman T, Flashman KG, Skull AJ, Senapati A, O’Leary DP, Parvaiz A (2010) Laparoscopic colorectal surgery produces better outcomes for high risk cancer patients compared to open surgery. Ann Surg Jul 252(1):84–89
Conflicts of interest
None.
Author information
Authors and Affiliations
Corresponding author
Rights and permissions
About this article
Cite this article
Hoffmann, M., Phillips, C., Oevermann, E. et al. Multivisceral and standard resections in colorectal cancer. Langenbecks Arch Surg 397, 75–84 (2012). https://doi.org/10.1007/s00423-011-0854-z
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s00423-011-0854-z