Department of General Surgery, Kartal Education and Research Hospital, Istanbul, Turkey.
World J Surg Oncol. 2012 Feb 15;10:39. doi: 10.1186/1477-7819-10-39.
Locally advanced colorectal cancers are best treated with multivisceral resections. The aim of this study is to evaluate early and late results after multivisceral resections.
All patients operated for primary colorectal cancer between 2001 and 2010 were -reviewed. These were compared within the patients underwent single organ and multivisceral resections: demographics, tumor and procedure related parameters, perioperative results, early oncological outcomes and 5-year survival.
A total of 354 patients (59.6 ± 13.8 years old, 210 [59.3%] males) were abstracted. Ninety (25.4%) patients underwent multivisceral resections for clinical T4 tumors and en-bloc R0 resection was achieved in 82 (91.1%). Only 31 (34.4% and 8.8% of clinical T4 and all cancers, respectively) cases had actual adjacent organ invasions (pT4). Males (20%) had lower risk for locally advanced tumors than females (33.3%) (p < 0.05). PT4 cancers were more common, if the clinical T4 tumor is located in the colon (48.8% vs 21.3%; p < 0.01). Laparoscopy was seldom initiated and the risk of conversion was higher in clinical T4 tumors (p < 0.05). The rates of sphincter-saving procedures were not different. Operation time, bleeding and transfusion requirements increased when multivisceral resections were necessitated (p < 0.05), but hospital stay, complications and 30-day mortality rates were similar. The 5-year survival rates were identical (p > 0.05).
Clinical T4 tumors are not rare and more common in women. An actual invasion (pT4) may be observed in one third of all clinical T4 tumors, and more frequent in colon cancers. An en-bloc, R0, multivisceral resection may be achieved in most cases. Multivisceral resections do not alter the rates of sphincter-saving procedures, morbidity and 30-day mortality; do not worsen survival but increase operation time, intraoperative bleeding and perioperative transfusion requirements.
局部晚期结直肠癌的最佳治疗方法是多脏器切除术。本研究旨在评估多脏器切除术后的早期和晚期结果。
回顾性分析 2001 年至 2010 年间接受原发性结直肠癌手术的所有患者。将这些患者分为单器官切除术和多脏器切除术两组：比较两组患者的人口统计学、肿瘤和手术相关参数、围手术期结果、早期肿瘤学结果和 5 年生存率。
共提取了 354 名患者（59.6±13.8 岁，210 名男性[59.3%]）的资料。90 名（25.4%）患者因临床 T4 肿瘤行多脏器切除术，82 名（91.1%）患者达到了整块 R0 切除。仅有 31 名（分别占临床 T4 和所有癌症的 34.4%和 8.8%）患者存在实际的邻近器官侵犯（pT4）。男性（20%）比女性（33.3%）患局部晚期肿瘤的风险低（p<0.05）。如果临床 T4 肿瘤位于结肠，则更常见 pT4 癌症（48.8%比 21.3%；p<0.01）。腹腔镜手术很少开始，临床 T4 肿瘤的转化率更高（p<0.05）。保肛手术的比例没有差异。需要多脏器切除术时，手术时间、出血和输血需求增加（p<0.05），但住院时间、并发症和 30 天死亡率相似。5 年生存率相同（p>0.05）。
临床 T4 肿瘤并不罕见，且女性更为常见。所有临床 T4 肿瘤中约有三分之一存在实际侵犯（pT4），且在结肠癌中更为常见。大多数情况下可实现整块、R0、多脏器切除术。多脏器切除术不会改变保肛手术、发病率和 30 天死亡率的比例；不会降低生存率，但会增加手术时间、术中出血和围手术期输血需求。
