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The Impact of a Multivisceral Resection and Adjuvant Therapy in Locally Advanced Colon Cancer

Journal of Gastrointestinal Surgery volume 23, pages 357–366 (2019)Cite this article

Abstract

Background

Multivisceral resection for locally advanced colon cancer is mandatory to achieve complete tumor resection. We aimed to determine if local multivisceral resections (LMR) for pT4 and pT3 tumors impact perioperative and long-term oncological outcomes.

Methods

All stage II or III colon cancer patients who had surgery between 2004 and 2014 were identified. We analyzed patients with non-multivisceral resections (NMR) for pT4 tumors vs. pT4-LMR. In addition, outcomes were compared to both NMR and LMR pT3 patients.

Results

LMR was performed in 55 (29.7%) of all patients with pT4 tumors and in 48 (8.9%) of all patients with pT3 tumors. The most commonly involved areas of extension were the abdominal wall and the small intestine. Transverse colon cancer was correlated with LMR. Morbidity rates were comparable between NMR and LMR, with the exception of higher rates of blood transfusion and postoperative ileus. Over one third of all pT4-NMR patients developed recurrent disease, which was higher compared to all other groups. Subsequently, overall and disease-specific survival, as well as disease-free survival (DFS), was worse for pT4-NMR, even after adjustment for pTN-staging, adjuvant therapy, and R0 resection. Furthermore, when analyzing only curative resections, radial margin < 1 cm along with nodal disease was independent predictor for worse DFS. Long-term outcomes were comparable between pT4-LMR and pT3 patients.

Conclusions

Multivisceral resection for locally advanced colon cancer preserves long-term oncological outcomes without increased postoperative morbidity. Moreover, LMR in pT3 tumors does not contribute to postoperative morbidity. Our study underlines the feasibility and importance of performing LMR when locally advanced cancer is suspected.

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Funding

LL received a grant from the Prins Bernhard Cultuurfonds and Hendrik Muller’s Fonds.

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Affiliations

  1. Department of General and Gastrointestinal Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA

    Lieve G. J. Leijssen, Anne M. Dinaux, R. Amri, Hiroko Kunitake, Liliana G. Bordeianou & David L. Berger

Authors
  1. Lieve G. J. Leijssen
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  2. Anne M. Dinaux
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  3. R. Amri
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  4. Hiroko Kunitake
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  5. Liliana G. Bordeianou
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  6. David L. Berger
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Contributions

All authors have contributed to this manuscript in the following way: substantial contributions to the conception or design of the work, or the acquisition, analysis, or interpretation of the data. Furthermore, all authors drafted or revised the manuscript critically for important intellectual content. All authors approved the final version and agreed to be accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved.

Corresponding author

Correspondence to David L. Berger.

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This study was approved by the Institutional Review Board.

Conflict of Interest

The authors declare that they have no conflict of interest.

Additional information

Scientific meeting presentations

Poster presentation at ASCRS Tripartite Meeting (June 10–14, 2017, Seattle, WA)

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Leijssen, L.G.J., Dinaux, A.M., Amri, R. et al. The Impact of a Multivisceral Resection and Adjuvant Therapy in Locally Advanced Colon Cancer. J Gastrointest Surg 23, 357–366 (2019). https://doi.org/10.1007/s11605-018-3962-z

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  • DOI: https://doi.org/10.1007/s11605-018-3962-z

Keywords

  • Colon cancer
  • Surgery
  • Tumor invasion
  • Multivisceral resection
  • Morbidity
  • Survival