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.
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.
Email this article (Login required) 
