Oncological outcome audit of multivisceral resections for primary colorectal cancer: a single centre experience

  • Ivan B Dimitrijevic Clinical Centre of Serbia, First Surgical Clinic, Clinic for Digestive Surgery, Belgrade, Serbia; University of Belgrade, Faculty of Medicine, Belgrade, Serbia
  • Goran Barisic Clinical Centre of Serbia, First Surgical Clinic, Clinic for Digestive Surgery, Belgrade, Serbia; University of Belgrade, Faculty of Medicine, Belgrade, Serbia
  • Velimir Markovic Clinical Centre of Serbia, First Surgical Clinic, Clinic for Digestive Surgery, Belgrade, Serbia; University of Belgrade, Faculty of Medicine, Belgrade, Serbia
  • Predrag Gavrilovic Centre for Medical Informatics, Belgrade, Serbia
  • Marica Bašić Anti Cancer Association “Qeen Hellen of Anjou” Kraljevo, Serbia
  • Zoran Krivokapic Clinical Centre of Serbia, First Surgical Clinic, Clinic for Digestive Surgery, Belgrade, Serbia; University of Belgrade, Faculty of Medicine, Belgrade, Serbia
DOI: https://doi.org/10.2298/VSP180101035D
Ključne reči: colorectal neoplasms, neoplasm invasiviness, neoplasm staging, surgical procedures, operative, prognosis

Sažetak


Abstract

 

Background/Aim. Colorectal cancer still presents a major health problem, with around 10% of patients in whom the tumor invades surrounding structures or organs. These pa­tients are usually challenging even for an experienced colo­rectal surgical team. The decision for performing multivis­ceral resection (MVR) is often made intraoperatively, with no sufficient data on the tumor and patient condition. The percentage of perioperative morbidity and mortality is high and oncological outcome is often unfavorable.The aim of this study was to investigate the poor oncological outcome risk factors after MVR in the patients with colorectal carci­noma. Methods. This was a retrospective analysis of pa­tients operated at the Department for Colorectal Surgery of the First Surgical Clinic, Clinical Centre of Serbia, Belgrade. The en bloc multivisceral resection for the primary adenocar­cinoma of the colon and rectum was uniformly performed. Data were collected in prospectively designed database. Follow-up period was minimum 2 years. The patients were analyzed in terms of histopathological, demographical and follow-up data. Survival and time to recurrence were evalu­ated using the Kaplan–Meier method and the log-rank test. Results. Two hundred and thirteen patients were included in the study Their mean age was 59.9 ±12.0 years. The fol­low-up period was 33.8 ±29 months. Histopathology con­firmed the true tumor infiltration of surrounding or­gan/structure in 126 (59.2%) patients. The R0 resection was confirmed in 173 (81.2%) patients. Five-year overall survival was 43.4%. Five-year survival for colon patients was 45.9% and in the rectal cancer group 40.9%. In the N0 group of patients, the overall survival in 5-year period was 66.7%. The N1 and N2 status proved the adverse effect on survival (overall 5-year survival 31.3% and 15.9%, respectively). The five-year local recurrence rate in the R0 group of patients was 17.7% and the percentage of distant metastases was 66.3%. Conclusion. The multivisceral resections are de­manding procedures requiring a highly specialized surgical team and a high volume hospital. The oncological outcome of these procedures is still unfavorable. In the cases with the node positive disease, or the R1 resection, the perspective is poor. On the other hand, in the absence of these unfavor­able factors, we can expect a good oncological outcome. More meticulous preoperative staging and aggressive preop­erative treatment can further improve the results.

Reference

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Objavljeno
2021/07/06
Broj časopisa
Vol. 76 Br. 12 (2019): Vojnosanit Pregl
Rubrika
Originalni članak