[Surgery of far-advanced colorectal cancer--extension of surgical indications and its results].

As there has been much progress in pre- and post-operative management, the safety of aggressive surgery has been improved, making this approach more widely available. Total pelvic eviscerations were performed for fifty-one patients with far-advanced rectal cancer which involved adjacent organs. The results were a 33% 5-year survival rate and 2 operative deaths. Even for patients with distant metastasis elsewhere, total pelvic evisceration may be acceptable for the good control of local pelvic symptoms (severe pain, infections, etc.). This operation is not, however, indicated for cases in which complete removal of the cancerous mass seem to be impossible. For advanced rectal cancer with a high degree of lymph-node metastasis, extension of lymph-node dissection up to the para-aortic region or ileo-pelvic lateral dissection en bloc with the internal iliac vessels were effective for decreasing the incidence of local recurrence. For forty-nine patients with liver metastasis, radical surgery with removal of liver metastatic lesions was carried out and the resulting 5-year survival rate was 30%. Removal of pulmonary metastatic lesions was also performed in thirty-four patients and the 5-year survival rate was 45%. The surgical results were poor in cases of multiple metastatic lesions in the liver or lung or of peritoneal dissemination. Extended surgery for far-advanced colorectal cancer may thus be actively undertaken unless multiple metastatic lesions are present.