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Multivisceral ‘en-bloc` resections of colorectal tumours - milestones in the surgical techniques

K. Draganov, V. Marinov, A. Petreska, D. Rusenov, Y. Kolev, B. Borisov, N. Katev, D. Penchev, G. Chengalova, S. Lavchev, D. Stoyanova, S. Tonev, R. Gaydarski

Abstract

Purpose: Colorectal tumours (CRT) consisting mainly of colorectal cancer (CRC) are diagnosed sometimes at an advanced T4 stage, i. e. local involvement of neighbouring organ/organs and anatomical structure/ structures. Aggressive surgical approach preceded and/or followed by neo-adjuvant/adjuvant therapy is advocated because of proven benefit for the patient. The aim of this study was to carry out a literature survey, on the one hand, and to analyze the cases from the authors` institutional experience, on the other hand, in an attempt to submit for consideration the milestones of the multivisceral en-block resections in cases of locally advanced CRTs, i.e. to describe the specific surgical approaches depending on different tumour location and peritumoural involvement of adjacent structures and organs.

Material and methods: A retrospective analysis of 154 cases of CRT was performed, all of them operated in the Clinic of Liver, Biliary, Pancreatic and General Surgery, Tokuda Hospital of Sofia, from January 1, 2007 to March 31, 2013. All the patients were diagnosed in an advanced T4-stage and received multivisceral en-bloc resections. Three main groups of methods that had been used were analyzed: 1) preoperative diagnosis, giving a hint of multivisceral en-bloc resection; 2) intraoperative assessment - gross tumour appearance, frozen sections (?), final histological examinations, and 3) surgical methods.

Results: Early morbidity and mortality rates were 22,6% and 5,8%, respectively, without any significant difference when compared with ‘simple` colon and rectum resections and with literature data available.

Conclusion: Multivisceral en-bloc resection for CRCs has been performed in more than 10% of the cases. It benefits the long-term prognosis. Tumour location and number of resected organs are essential characteristics of these procedures and they are independently associated with the quantity of intraoperative blood loss, higher early morbidity rates and more frequent local recurrence.


Keywords

colorectal cancer; T4 colorectal cancer; multivisceral ‘en-bloc` resection; surgical methods; case reports

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References

Amshel, C., S. Avital, A. Miller, L. Sands, F.

Marchetti, M. Hellinger. T4 rectal cancer: analysis

of patient outcome after surgical excision.- Am.

Surg., 71, 2005, No 11, 901-903, discussion 904.

Curley, S. A., G. W. Carlson, C. R. Shumate, K.

I. Wishnow, F. C. Ames. Extended resection for

locally advanced colorectal carcinoma.- Am. J.

Surg., 163, 1992, No 6, 553-559.

Devine, R. M., R. R. Dozois. Surgical management

of locally advanced adenocarcinoma of the

rectum.- World J. Surg., 16, 1992, No 3, 486-489.

Eisenberg, S. B., W. G. Kraybill, M. J. Lopez.

Long-term results of surgical resection of locally

advanced colorectal carcinoma.- Surgery, 108,

, No 4, 779-785, discussion 785-786.

Gall, F. P., J. Tonak, A. Altendorf. Multivisceral

resections in colorectal cancer.- Dis. Colon Rectum,

, 1987, No 5, 337-341.

Gebhardt, C., W. Meyer, S. Ruckriegel, U. Meier.

Multivisceral resection of advanced colorectal

carcinoma.- Langenbeck`s Arch. Surg., 384, 1999,

No 2, 194-199.

Gezen, C., M. Kement, Y. E. Altuntas, N. Okkabaz,

M. Seker, S. Vural, et al. Results after multivisceral

resections of locally advanced colorectal cancers:

an analysis on clinical and pathological T4 tumors.-

World J. Surg. Oncol., 10, 2012 Feb 15, 39. doi:

1186/1477-7819-10-39.

Hermanek, P. Multiviscerale Resektion beim

kolorektalen Karzinom - Erfahrungen der

SGKRK-Studie.- Langenbeck`s Arch. Chir. Suppl.

Kongressband, 377, 1992, 95-100.

Hermanek, P., U. Mansmann, D. Staimmer, S.

Riedl, P. Hermanek. The German experience: the

surgeon as a prognostic factor in colon and rectal

surgery.- Surg. Clin. North Am., 9, 2000, No 1, 33-

, vi.

Hunter, J. A., J. A. Ryan, Jr., P. Schultz. En bloc

resection of colon cancer adherent to other organs.-

Am. J. Surg., 145, 1987, No 1, 67-71.

Izbicki, J. R., S. B. Hosch, W. T. Knoefel, B. Passlick,

C. Bloechle, C. E. Broelsch. Extended resections

are beneficial for patients with locally advanced

colorectal cancer.- Dis. Colon Rectum, 38, 1995,

No 12, 1251-1256.

Kapoor, S., B. Das, S. Pal, P. Sahni, T. K.

Chattopadhyay. En bloc resection of right-sided

colonic adenocarcinoma with adjacent organ

invasion.- Int. J. Colorectal Dis., 21, 2006, No 3,

-268.

Lehnert, T., M. Methner, A. Pollok, A. Schaible,

U. Hinz, C. Herfarth. Multivisceral resection for

locally advanced primary colon and rectal cancer.

An analysis of prognostic factors in 201 patients.-

Ann. Surg., 235, 2002, No 2, 217-225.

Luna-Perez, P., S. E. Rodriguez-Ramirez, M. G. De

la Barrera, M. Zeferino, S. Labastida. Multivisceral

resection for colon cancer.- J. Surg. Oncol., 80, 2002,

No 2, 100-104.

Montesani, C., G. Ribotta, R. De Milito, A. Pronio,

A. D`Amato, P. Narilli, et al. Extended resection in

the treatment of colorectal cancer.- Int. J. Colorectal

Dis., 6, 1991, No 3, 161-164.

Nakafusa, Y., T. Tanaka, M. Tanaka, Y. Kitajima,

S. Sato, K. Miyazaki. 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, 2004, No 12, 2055-2063.

Nelson, H., N. Petrelli, A. Carlin, J. Couture, J.

Fleshman, J. Guillem, et al.; National Cancer

Institute Expert Panel. Guidelines 2000 for colon

and rectal surgery.- J. Natl Cancer Inst., 93, 2001,

No 8, 583-596.

Otchy, D., N. H. Hyman, C. Simmang, T. Anthony,

W. D. Buie, P. Cataldo, et al.; Standards Practice

Task Force; American Society of Colon and Rectal

Surgeons. Practice parameters for colon cancer.-

Dis. Colon Rectum, 47, 2004, No 8, 1269-1284.

Poeze, M., J. G. Houbiers, C. J. van de Velde, T.

Wobbes, M. F. von Meyenfeldt. Radical resection of

locally advanced colorectal cancer.- Br. J. Surg., 82,

, No 10, 1386-1390.

Staib, L., K. H. Link, A. Blatz, H. G. Berger.

Surgery of colorectal cancer: surgical morbidity

and five- and ten-year results in 2400 patients -

monoinstitutional experience.- World J. Surg., 26,

, No 1, 59-66.

Sugarbaker, E. D. Coincident removal of additional

structures in resections for carcinoma of the

colon and rectum.- Ann. Surg., 123, 1946, No 6,

-1046.

Tjandra, J. J., J. W. Kikenny, W. D. Buie, N. Hyman,

C. Simmang, T. Anthony, et al.; Standards Practice

Task Force; American Society of Colon and Rectal

Surgeons. Practice parameters for the management

of rectal cancer.- Dis. Colon Rectum, 48, 2005,

No 3, 411-423.




DOI: http://dx.doi.org/10.14748/ssm.v45i0.869

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About The Authors

K. Draganov
Tokuda Hospital of Sofia
Bulgaria

Clinic of Liver, Biliary, Pancreatic and General Surgery

V. Marinov
Tokuda Hospital of Sofia
Bulgaria

Clinic of Liver, Biliary, Pancreatic and General Surgery

A. Petreska
Tokuda Hospital of Sofia
Bulgaria

Clinic of Liver, Biliary, Pancreatic and General Surgery

D. Rusenov
Tokuda Hospital of Sofia
Bulgaria

Clinic of Liver, Biliary, Pancreatic and General Surgery

Y. Kolev
Tokuda Hospital of Sofia
Bulgaria

Clinic of Liver, Biliary, Pancreatic and General Surgery

B. Borisov
Tokuda Hospital of Sofia
Bulgaria

Clinic of Liver, Biliary, Pancreatic and General Surgery

N. Katev
Tokuda Hospital of Sofia
Bulgaria

Clinic of Liver, Biliary, Pancreatic and General Surgery

D. Penchev
Tokuda Hospital of Sofia
Bulgaria

Clinic of Liver, Biliary, Pancreatic and General Surgery

G. Chengalova
Tokuda Hospital of Sofia
Bulgaria

Clinic of Liver, Biliary, Pancreatic and General Surgery

S. Lavchev
Tokuda Hospital of Sofia
Bulgaria

Clinic of Liver, Biliary, Pancreatic and General Surgery

D. Stoyanova
Tokuda Hospital of Sofia
Bulgaria

Clinic of Liver, Biliary, Pancreatic and General Surgery

S. Tonev
Tokuda Hospital of Sofia
Bulgaria

Clinic of Liver, Biliary, Pancreatic and General Surgery

R. Gaydarski
Tokuda Hospital of Sofia
Bulgaria

Clinic of Liver, Biliary, Pancreatic and General Surgery

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