Skip to main content

Advertisement

SpringerLink
Log in

Multivisceral Resection in Colorectal Cancer: A Systematic Review

  • Colorectal Cancer
  • Published:
Annals of Surgical Oncology Aims and scope Submit manuscript

Abstract

Background

The objective of this study was to critically evaluate current literature on outcomes following multivisceral resection (MVR) in colorectal cancer (CRC). Adequate surgical resection with clear margins is imperative in achieving long-term survival in colorectal cancer. Where there is adherence to or invasion of adjacent organs, (MVR) may be needed to achieve complete disease clearance.

Methods

A systematic review of MVR in CRC was performed. Pubmed/Medline and Cochrane databases were searched for English language articles from 1995 to 2012 using a predefined strategy. Retrieved abstracts were independently screened for relevance and data extracted from selected studies by 2 researchers. Results are reported as weighted means.

Results

Included were 22 studies comprising 1575 patients (87.0 % primary colorectal cancer; 13.0 % recurrent, 63.8 % rectal; 36.2 % colon). The most common organs resected were the bladder and reproductive organs. The perioperative mortality was 4.2 % with morbidity of 41.5 % (95 % CI, 40.8–42.2 %). The overall 5-year survival rate was 50.3 % (95 % CI, 49.9–50.8 %). Surgery for recurrence was associated with worse outcomes than primary tumors with 5-year survival 19.5 % (95 % CI, 17.8–21.1 %) for recurrent rectal cancer and primary rectal tumors 5-year overall survival 52.8 % (95 % CI, 52.0–53.8 %). R0 resection was the strongest factor associated with long-term survival.

Conclusions

Multivisceral resection provides the best possibility of long-term survival in locally advanced primary colorectal cancer in which a clear margin has been achieved.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

References

  1. How P, Shihab O, Tekkis P, Brown G, Quirke P, Heald R, et al. A systematic review of cancer related patient outcomes after anterior resection and abdominoperineal excision for rectal cancer in the total mesorectal excision era. Surg Oncol. 2011;20:e149–55.

    Article  PubMed  CAS  Google Scholar 

  2. Davies M, Harris D, Hirst G, Beynon R, Morgan AR, Carr ND, et al. Local recurrence after abdomino-perineal resection. Colorectal Dis. 2009;11:39–43.

    Article  PubMed  CAS  Google Scholar 

  3. Nielsen MB, Laurberg S, Holm T. Current management of locally recurrent rectal cancer. Colorectal Dis. 2011;13:732–42.

    Article  PubMed  CAS  Google Scholar 

  4. Hida J, Yasutomi M, Maruyama T, Nakajima A, Uchida T, Wakano T, et al. Results from pelvic exenteration for locally advanced colorectal cancer with lymph node metastases. Dis Colon Rectum. 1998;41:165–8.

    Article  PubMed  CAS  Google Scholar 

  5. Gebhardt C, Meyer W, Ruckriegel S, Meier U. Multivisceral resection of advanced colorectal carcinoma. Langenbecks Arch Surg. 1999;384:194–9.

    Article  PubMed  CAS  Google Scholar 

  6. Davies ML, Harris D, Davies M, Lucas M, Drew P, Beynon J. Selection criteria for the radical treatment of locally advanced rectal cancer. Int J Surg Oncol. 2011;2011:678506.

    PubMed  Google Scholar 

  7. Sugarbaker ED. Coincident removal of additional structures in resections for carcinoma of the colon and rectum. Ann Surg. 1946;123:1036–46.

    Article  Google Scholar 

  8. Chen YG, Liu YL, Jiang SX, Wang XS. Adhesion pattern and prognosis studies of T4N0M0 colorectal cancer following en bloc multivisceral resection: evaluation of T4 subclassification. Cell Biochem Biophys. 2011;59:1–6.

    Article  PubMed  CAS  Google Scholar 

  9. Bartos A, Bartos D, Dunca F, Mocanu L, Zaharie F, Iancu M, et al. Multi-organ resections for colorectal cancer: analysis of potential factors with role in the occurrence of postoperative complications and deaths. Chirurgia (Bucur). 2012;107:476–82.

    PubMed  CAS  Google Scholar 

  10. Govindarajan A, Coburn NG, Kiss A, Rabeneck L, Smith AJ, Law CH. Population-based assessment of the surgical management of locally advanced colorectal cancer. J Natl Cancer Inst. 2006;98:1474–81.

    Article  PubMed  Google Scholar 

  11. Liberati A, Altman DG, Tetzlaff J, Mulrow C, Gøtzsche PC, Ioannidis JP, et al. The PRISMA statement for reporting systematic reviews and meta-analyses of studies that evaluate healthcare interventions: explanation and elaboration. BMJ. 2009;339:b2700.

    Article  PubMed  Google Scholar 

  12. Moher D, Liberati A, Tetzlaff J, Altman DG. Preferred reporting items for systematic reviews and meta-analyses: the PRISMA statement. BMJ. 2009;339:b2535.

    Article  PubMed  Google Scholar 

  13. Borowski DW, Bradburn DM, Mills SJ, Bharathan B, Wilson RG, Ratcliffe AA, et al. Volume-outcome analysis of colorectal cancer-related outcomes. Br J Surg. 2010;97:1416–30.

    Article  PubMed  CAS  Google Scholar 

  14. Downs SH, Black N. The feasibility of creating a checklist for the assessment of the methodological quality both of randomised and non-randomised studies of health care interventions. J Epidemiol Community Health. 1998;52:377–84.

    Article  PubMed  CAS  Google Scholar 

  15. Nielsen M, Rasmussen P, Lindegaard J, Laurberg S. A 10-year experience of total pelvic exenteration for primary advanced and locally recurrent rectal cancer based on a prospective database. Colorectal Dis. 2012;14:1076–83.

    Article  PubMed  CAS  Google Scholar 

  16. Saito N, Suzuki T, Tanaka T, Sugito M, Ito M, Kobayashi A, et al. Preliminary experience with bladder preservation for lower rectal cancers involving the lower urinary tract. J Surg Oncol. 2010;102:778–83.

    Article  PubMed  Google Scholar 

  17. Oledzki J, Chwalinski M, Rogowski W, Sopylo R, Nowacki MP. Total cystectomies in the surgical treatment of rectal cancer with prior chemoradiation: analysis of postoperative morbidity and survival. Int J Colorectal Dis. 2004;19:124–7.

    Article  PubMed  Google Scholar 

  18. Bannura GC, Barrera AE, Cumsille MA, Contreras JP, Melo CL, Soto DC, et al. Posterior pelvic exenteration for primary rectal cancer. Colorectal Dis. 2006;8:309–13.

    Article  PubMed  CAS  Google Scholar 

  19. Park S, Lee YS. Analysis of the prognostic effectiveness of a multivisceral resection for locally advanced colorectal cancer. J Korean Soc Coloproctol. 2011;27:21–6.

    Article  PubMed  Google Scholar 

  20. Nakafusa Y, Tanaka T, Tanaka M, Kitajima Y, Sato S, Miyazaki K. 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. 2004;47:2055–63.

    Article  PubMed  Google Scholar 

  21. Ike H, Shimada H, Yamaguchi S, Ichikawa Y, Fujii S, Ohki S. Outcome of total pelvic exenteration for primary rectal cancer. Dis Colon Rectum. 2003;46:474–80.

    Article  PubMed  Google Scholar 

  22. Ike H, Shimada H, Ohki S, Yamaguchi S, Ichikawa Y, Fujii S. Outcome of total pelvic exenteration for locally recurrent rectal cancer. Hepatogastroenterology. 2003;50:700–3.

    PubMed  Google Scholar 

  23. Harris DA, Davies M, Lucas MG, Drew P, Carr ND, Beynon J. Multivisceral resection for primary locally advanced rectal carcinoma. Br J Surg. 2011;98:582–8.

    Article  PubMed  CAS  Google Scholar 

  24. McNamara DA, Fitzpatrick JM, O’Connell PR. Urinary tract involvement by colorectal cancer. Dis Colon Rectum. 2003;46:1266–76.

    Article  PubMed  Google Scholar 

  25. Lehnert T, Methner M, Pollok A, Schaible A, Hinz U, Herfarth C. Multivisceral resection for locally advanced primary colon and rectal cancer: an analysis of prognostic factors in 201 patients. Ann Surg. 2002;235:217–25.

    Article  PubMed  Google Scholar 

  26. Vermaas M, Ferenschild FT, Verhoef C, Nuyttens JJ, Marinelli AW, Wiggers T, et al. Total pelvic exenteration for primary locally advanced and locally recurrent rectal cancer. Eur J Surg Oncol. 2007;33:452–8.

    Article  PubMed  CAS  Google Scholar 

  27. Lopez-Cano M, Manas MJ, Hermosilla E, Espin E. Multivisceral resection for colon cancer: analysis of prognostic factors. Dig Surg. 2010;27:238–45.

    Article  PubMed  Google Scholar 

  28. Jimenez RE, Shoup M, Cohen AM, Paty PB, Guillem J, Wong WD. Contemporary outcomes of total pelvic exenteration in the treatment of colorectal cancer. Dis Colon Rectum. 2003;46:1619–25.

    Article  PubMed  Google Scholar 

  29. Ike H, Shimada H, Fujii S, Kamimukai N, Ohshima T, Imada T. Extended abdominoperineal resection with partial prostatectomy for T3 rectal cancer. Hepatogastroenterology. 2003;50:377–9.

    PubMed  Google Scholar 

  30. Cukier M, Smith AJ, Milot L, Chu W, Chung H, Fenech D, et al. Neoadjuvant chemoradiotherapy and multivisceral resection for primary locally advanced adherent colon cancer: A single institution experience. Eur J Surg Oncol. 2012;38:677–82.

    Article  PubMed  CAS  Google Scholar 

  31. Luna-Perez P, Rodriguez-Ramirez SE, De la Barrera MG, Zeferino M, Labastida S. Multivisceral resection for colon cancer. J Surg Oncol. 2002;80:100–4.

    Article  PubMed  Google Scholar 

  32. Winter DC, Walsh R, Lee G, Kiely D, O’Riordain MG, O’Sullivan GC. Local involvement of the urinary bladder in primary colorectal cancer: outcome with en-bloc resection. Ann Surg Oncol. 2007;14:69–73.

    Article  PubMed  CAS  Google Scholar 

  33. Gezen C, Kement M, Altuntas YE, Okkabaz N, Seker M, Vural S, et al. Results after multivisceral resections of locally advanced colorectal cancers: an analysis on clinical and pathological t4 tumors. World J Surg Oncol. 2012;10:39.

    Article  PubMed  Google Scholar 

  34. Li JC, Chong CC, Ng SS, Yiu RY, Lee JF, Leung KL. En bloc urinary bladder resection for locally advanced colorectal cancer: a 17-year experience. Int J Colorectal Dis. 2011;26:1169–76.

    Article  PubMed  Google Scholar 

  35. Hoffmann M, Phillips C, Oevermann E, Killaitis C, Roblick UJ, Hildebrand P, et al. Multivisceral and standard resections in colorectal cancer. Langenbecks Arch Surg. 2012;397:75–84.

    Article  PubMed  Google Scholar 

  36. Derici H, Unalp HR, Kamer E, Bozdag AD, Tansug T, Nazli O, et al. Multivisceral resections for locally advanced rectal cancer. Colorectal Dis. 2008;10:453–9.

    Article  PubMed  CAS  Google Scholar 

  37. Smith JD, Nash GM, Weiser MR, Temple LK, Guillem JG, Paty PB. Multivisceral resection for rectal cancer Br J Surg. 2012;99:1137–43.

    CAS  Google Scholar 

  38. Yamada K, Ishizawa T, Niwa K, Chuman Y, Aikou T. Pelvic exenteration and sacral resection for locally advanced primary and recurrent rectal cancer. Dis Colon Rectum. 2002;45:1078–84.

    Article  PubMed  Google Scholar 

  39. Zoucas E, Frederiksen S, Lydrup ML, Mansson W, Gustafson P, Alberius P. Pelvic exenteration for advanced and recurrent malignancy. World J Surg. 2010;34:2177–84.

    Article  PubMed  Google Scholar 

  40. Hunter JA, Ryan JA, Jr., Schultz P. En bloc resection of colon cancer adherent to other organs. Am J Surg. 1987;154:67–71.

    Article  PubMed  CAS  Google Scholar 

  41. Law WL, Chu KW, Choi HK. Total pelvic exenteration for locally advanced rectal cancer. J Am Coll Surg. 2000;190:78–83.

    Article  PubMed  CAS  Google Scholar 

  42. Shirouzu K, Isomoto H, Kakegawa T. Total pelvic exenteration for locally advanced colorectal carcinoma. Br J Surg. 1996;83:32–5.

    Article  PubMed  CAS  Google Scholar 

  43. Poeze M, Houbiers JG, van de Velde CJ, Wobbes T, von Meyenfeldt MF. Radical resection of locally advanced colorectal cancer. Br J Surg. 1995;82:1386–90.

    Article  PubMed  CAS  Google Scholar 

  44. Martin ST, Heneghan HM, Winter DC. Systematic review and meta-analysis of outcomes following pathological complete response to neoadjuvant chemoradiotherapy for rectal cancer. Br J Surg. 2012;99:918–28.

    Article  PubMed  CAS  Google Scholar 

  45. Smith FM, Chang KH, Sheahan K, Hyland J, O’Connell PR, Winter DC. The surgical significance of residual mucosal abnormalities in rectal cancer following neoadjuvant chemoradiotherapy. Br J Surg. 2012;99:993–1001.

    Article  PubMed  CAS  Google Scholar 

  46. Tekkis PP, Poloniecki JD, Thompson MR, Stamatakis JD. Operative mortality in colorectal cancer: prospective national study. BMJ. 2003;327:1196–201.

    Article  PubMed  Google Scholar 

  47. Paun BC, Cassie S, MacLean AR, Dixon E, Buie WD. Postoperative complications following surgery for rectal cancer. Ann Surg. 2010;251:807–18.

    Article  PubMed  Google Scholar 

  48. Gannon CJ, Zager JS, Chang GJ, Feig BW, Wood CG, Skibber JM, et al. Pelvic exenteration affords safe and durable treatment for locally advanced rectal carcinoma. Ann Surg Oncol. 2007;14:1870–7.

    Article  PubMed  Google Scholar 

  49. Ishiguro S, Akasu T, Fujita S, Yamamoto S, Kusters M, Moriya Y. Pelvic exenteration for clinical T4 rectal cancer: oncologic outcome in 93 patients at a single institution over a 30-year period. Surgery. 2009;145:189–95.

    Article  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Department of Surgery, St. Vincent’s University Hospital, Dublin, Ireland

    H. M. Mohan MRCSI, J. O. Larkin PhD, FRCS & D. C. Winter MD, FRCS

  2. Department of Colorectal Surgery, Singleton Hospital, Swansea, UK

    M. D. Evans BM, MPhil, FRCS & J. Beynon MS

Authors
  1. H. M. Mohan MRCSI
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. M. D. Evans BM, MPhil, FRCS
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. J. O. Larkin PhD, FRCS
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. J. Beynon MS
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. D. C. Winter MD, FRCS
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to H. M. Mohan MRCSI.

Electronic supplementary material

Rights and permissions

Reprints and permissions

About this article

Cite this article

Mohan, H.M., Evans, M.D., Larkin, J.O. et al. Multivisceral Resection in Colorectal Cancer: A Systematic Review. Ann Surg Oncol 20, 2929–2936 (2013). https://doi.org/10.1245/s10434-013-2967-9

Download citation

  • Received:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1245/s10434-013-2967-9

Keywords

Search

Navigation