PURPOSE
The aim of the present study is to clarify the characteristics of multivisceral resection and to discuss strategies for improving the overall outcome of multivisceral resection for locally advanced colorectal cancer.
METHODS
The study included 323 patients who electively underwent curative surgery for pT3–pT4 colorectal carcinoma without distant metastasis. We evaluated the short-term and long-term outcome of multivisceral resection relative to that of the standard operation by means of multivariate analysis of the prognostic factors.
RESULTS
Of 323 patients, 53 (16.4 percent) received multivisceral resection because of adhesion to other organs. Multivisceral resection was significantly associated with tumor size, depth of invasion, operative blood loss, operation time, and blood transfusion (all: P < 0.0001). Overall morbidity rates were 49.1 percent after multivisceral resection vs. 17.8 percent after the standard operation (P < 0.0001), and postoperative mortality rate was 0 percent in both groups (not significant). Only multivisceral resection (odds ratio, 2.725; 95 percent confidence interval, 1.125–6.623; P = 0.0264) was an independent factor for overall postoperative complications. The survival rate of patients after multivisceral resection was similar to that after the standard operation (5-year rate, 76.6 percent vs. 79.5 percent, P = 0.9347). Lymph node metastasis (hazard ratio, 2.510; 95 percent confidence interval, 1.460–4.315; P = 0.0009) and blood transfusion (hazard ratio, 2.353; 95 percent confidence interval, 1.185–4.651; P = 0.0145) were independently associated with patient survival.
CONCLUSIONS
For locally advanced colorectal cancer, the long-term outcome after multivisceral resection is comparable to that after the standard operation. However, it should be recognized that multivisceral resection is associated with higher postoperative morbidity. In addition, a reduction in the incidence of blood transfusion may contribute to improving patient survival.
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REFERENCES
H Nelson N Petrelli A Carlin et al. (2001) ArticleTitleGuidlines 2000 for colon and rectal cancer surgery J Natl Cancer Inst 93 583–96 Occurrence Handle10.1093/jnci/93.8.583 Occurrence Handle1:STN:280:DC%2BD3M3hvFejtg%3D%3D Occurrence Handle11309435
T Lehnert M Methner A Pollok A Schaible U Hinz C Herfarth (2002) ArticleTitleMultiviscerral resection for locally advanced primary colon and rectal cancer. An analysis of prognostic factors in 201 patients Ann Surg 235 217–25 Occurrence Handle10.1097/00000658-200202000-00009 Occurrence Handle11807361
C Gebhardt W Meyer S Ruckriegel U Meier (1999) ArticleTitleMultivisceral resection of advanced colorectal carcinoma Langenbecks Arch Surg 384 194–9 Occurrence Handle10.1007/s004230050191 Occurrence Handle1:STN:280:DyaK1M3lvVOhtA%3D%3D Occurrence Handle10328174
C Montesani G Ribotta R Milito ParticleDe et al. (1991) ArticleTitleExtended resection in the treatment of colorectal cancer Int J Colorectal Dis 6 161–4 Occurrence Handle1:STN:280:DyaK38%2FnvVOhtg%3D%3D Occurrence Handle1744489
S Sokmen C Terzi T Unek H Alanyah M Fusun (1999) ArticleTitleMultivisceral resections for primary advanced rectal cancer Int J Colorectal Dis 14 282–5 Occurrence Handle10.1007/s003840050229 Occurrence Handle1:STN:280:DC%2BD3c7jtVehsg%3D%3D Occurrence Handle10663895
P Luna-Perez SE Rodoriguez-Ramirez MG Barrera M Zeferino S Labastida (2002) ArticleTitleMultivisceral resection for colon cancer J Surg Oncol 80 100–4 Occurrence Handle10.1002/jso.10105 Occurrence Handle12173378
JA Hunter JA Ryan P Schultz (1987) ArticleTitleEn bloc resection of colon cancer adherent to other organs Am J Surg 145 67–71
FP Gall J Tonak A Altendorf (1987) ArticleTitleMultivisceral resections in colorectal cancer Dis Colon Rectum 30 337–41 Occurrence Handle1:STN:280:DyaL2s7ovFCqtw%3D%3D Occurrence Handle3568922
SB Eisenberg WG Kraybill MJ Lopez (1990) ArticleTitleLong-term results of surgical resection of locally advanced colorectal cancer Surgery 108 779–86 Occurrence Handle1:STN:280:DyaK3M%2FhvFyktg%3D%3D Occurrence Handle2218891
TP McGlone WA Bernie DW Elliott (1982) ArticleTitleSurvival following extended operations for extracolonic invasion by colon cancer Arch Surg 117 595–9 Occurrence Handle1:STN:280:DyaL387otFGrtQ%3D%3D Occurrence Handle7073479
MR Pittam H Thornton H Ellis (1984) ArticleTitleSurvival after extended resection for locally advanced carcinoma of the colon and rectum Ann R Coll Surg Engl 66 81–4 Occurrence Handle1:STN:280:DyaL2c7lt1Cqsg%3D%3D Occurrence Handle6703633
VL Rowe DB Frost S Huang (1997) ArticleTitleExtended resection for locally advanced colorectal carcinoma Ann Surg Oncol 4 131–6 Occurrence Handle1:STN:280:DyaK2s3jvFWlsw%3D%3D Occurrence Handle9084849
JR Izbicki SB Hosch WT Knoefel B Passlick C Bloechle CE Broesch (1995) ArticleTitleExtended resections are beneficial for patients with locally advanced colorectal cancer Dis Colon Rectum 38 1251–6 Occurrence Handle1:STN:280:DyaK287gtFGmsQ%3D%3D Occurrence Handle7497835
M Aleksic N Hennes B Ulrich (1998) ArticleTitleSurgical treatmet of locally advanced rectal cancer. Options and strategies Dis Surg 15 342–6 Occurrence Handle10.1159/000018629 Occurrence Handle1:STN:280:DyaK1M%2Fmt1Wnug%3D%3D
M Poeze JG Houbiers CJ Velde Particlevan de T Wobbes MF Meyenfeldt Particlevon (1995) ArticleTitleRadical resection of locally advanced colorectal cancer Br J Surg 82 1386–90 Occurrence Handle1:STN:280:DyaK28%2Fpslygtg%3D%3D Occurrence Handle7489174
SF Heslov DB Frost (1988) ArticleTitleExtended resection for primary colorectal carcinoma involving adjacent organs or structures Cancer 62 1637–40 Occurrence Handle1:STN:280:DyaL1M%2Fgt1Khug%3D%3D Occurrence Handle3167778
L Staib KH Link A Blatz HG Berger (2002) ArticleTitleSurgery of colorectal cancer: surgical morbidity and five- and ten-year results in 2400 patients –- monoinstitutional experience World J Surg 26 59–66 Occurrence Handle10.1007/s00268-001-0182-5 Occurrence Handle11898035
GH Hafner L Herrera NJ Petrelli (1992) ArticleTitleMorbidity and mortality after pelvic exenteration for colorectal adenocarcinoma Ann Surg 215 63–7 Occurrence Handle1:STN:280:DyaK387hslOntg%3D%3D Occurrence Handle1731650
SA Curley DB Evans FC Ames (1994) ArticleTitleResection for cure of carcinoma of the colon directly invading the duodenum and pancreatic head J Am Coll Surg 179 587–92 Occurrence Handle1:STN:280:DyaK2M%2FktVWqsw%3D%3D Occurrence Handle7952464
Jinnai, D. General rules for clinical and pathological studies on cancer of the colon, rectum, and anus. Part I. Clinical classification. Japanese Research Society for Cancer of the Colon and Rectum. Jpn J Surg 1983;13:557–73.
T Mynster IJ Christensen F Moesgaard HJ Nielsen (2000) ArticleTitleEffects of the combinaton of blood transfusion and postoperative infectious complications on prognosis after surgery for colorectal cancer Br J Surg 87 1553–62 Occurrence Handle10.1046/j.1365-2168.2000.01570.x Occurrence Handle1:STN:280:DC%2BD3M%2FltFOhsQ%3D%3D Occurrence Handle11091245
AC Melling B Ali ME Scott DJ Leaper (2001) ArticleTitleEffects of preoperative warming on the incidence of wound infection after clean surgery: a randomized controlled trial Lancet 356 876–80 Occurrence Handle10.1016/S0140-6736(01)06071-8
NJ Keeling MW Morgan (1995) ArticleTitleInpatient and postdischarge wound infection in general surgery Ann R Coll Surg Engl 77 245–7 Occurrence Handle1:STN:280:DyaK28%2FgsFOitw%3D%3D Occurrence Handle7574312
M Braga A Vignali L Gianotti et al. (2002) ArticleTitleLaparoscopic versus open colorectal surgery: a randomized trial on short-term outcome Ann Surg 236 759–67 Occurrence Handle10.1097/00000658-200212000-00008 Occurrence Handle12454514
E Lezoche F Feliciotti AM Paganini et al. (2002) ArticleTitleLaparoscopic vs open hemicolectomy for colon cancer Surg Endosc 16 596–602 Occurrence Handle10.1007/s00464-001-9053-2 Occurrence Handle1:STN:280:DC%2BD383jsVersw%3D%3D Occurrence Handle11972196
Y Moriya K Sugihara T Akasu S Fujita (1997) ArticleTitleImportance of extended lymphadenectomy with lateral node dissection for advanced lower rectal cancer World J Surg 21 728–32 Occurrence Handle10.1007/s002689900298 Occurrence Handle1:STN:280:DyaK2svit1Kmtg%3D%3D Occurrence Handle9276704
WE Enker N Merchant A Cohen et al. (1999) ArticleTitleSafety and efficacy of low anterior resection for rectal cancer: 681 consecutive cases from a specialty service Ann Surg 230 544–54 Occurrence Handle10.1097/00000658-199910000-00010 Occurrence Handle1:STN:280:DyaK1MvltVGmuw%3D%3D Occurrence Handle10522724
Y Nakafusa T Tanaka Y Kitajima S Sato Y Hirohashi K Miyazaki (2004) ArticleTitleModification of lymph node dissection for colon cancer by clinical diagnosis. Hepatogastroenterology 51 722–6 Occurrence Handle15143901
S Ascanelli G Navarra G Tonini et al. (2003) ArticleTitleEarly and late outcome after surgery for colorectal cancer: elective versus emergency surgery Tumori 89 36–41 Occurrence Handle12729359
EL Bokey PH Chapuis C Fung et al. (1995) ArticleTitlePostoperative morbidity and mortality following resection of the colon and rectum for cancer Dis Colon Rectum 38 480–7 Occurrence Handle1:STN:280:DyaK2M3lsV2ksg%3D%3D Occurrence Handle7736878
JH Anderson D Hole CS McArdle (1992) ArticleTitleElective versus emergency surgery for patients with colorectal cancer Br J Surg 79 706–9 Occurrence Handle1:STN:280:DyaK38zltlyitg%3D%3D Occurrence Handle1379508
E Mitry AM Bouvier J Esteve J Fivre (2002) ArticleTitleBenefit of operative mortality reduction on colorectal cancer survival Br J Surg 89 1557–62 Occurrence Handle10.1046/j.1365-2168.2002.02276.x Occurrence Handle1:STN:280:DC%2BD38noslajug%3D%3D Occurrence Handle12445066
T Muto K Kotake Y Koyama (2001) ArticleTitleColorectal cancer statistics in Japan: data from JSCCR registration, 1974-1993 Int J Clin Oncol 6 171–6 Occurrence Handle1:STN:280:DC%2BD3MnltlygtQ%3D%3D Occurrence Handle11706554
AC Amato M Pescatori (1998) ArticleTitleEffect of perioperative blood transfusion on recurrence of colorectal cancer: meta-analysis stratified on risk factors Dis Colon Rectum 41 570–85 Occurrence Handle1:STN:280:DyaK1c3lsVSksg%3D%3D Occurrence Handle9593238
I Garau E Benito FX Bosch et al. (1994) ArticleTitleBlood transfusion has no effect on colorectal cancer survival, A population-based study Eur J Cancer 30A 759–64 Occurrence Handle10.1016/0959-8049(94)90288-7 Occurrence Handle1:STN:280:DyaK2M%2FgtV2ntw%3D%3D Occurrence Handle7917533
TH Enda T Bjerkeset (1998) ArticleTitlePerioperative blood transfusions reduce long-term survival following surgery for colorectal cancer Dis Colon Rectum 41 451–9
R Tang JY Wang CR Chien JS Chen SE Lin HA Fan (1993) ArticleTitleThe association between perioperative blood transfusion and survival of patients with colorectal cancer Cancer 72 341–8 Occurrence Handle1:STN:280:DyaK3szgs1Gktg%3D%3D Occurrence Handle8319167
T Mynster HJ Nielsen (2001) ArticleTitleStorage time of transfused blood and disease recurrence after colorectal cancer surgery Dis Colon Rectum 44 955–64 Occurrence Handle1:STN:280:DC%2BD3MvkvFSitw%3D%3D Occurrence Handle11496075
LM Wartering Particlevan de A Brand JG Houbiers et al. (2001) ArticleTitlePerioperative blood transfusions, with or without allogeneic leucocytes, relate to survival, not to cancer recurrence Br J Surg 88 267–72 Occurrence Handle10.1046/j.1365-2168.2001.01674.x Occurrence Handle11167879
MA Blajchman (1998) ArticleTitleImmunomodulatory effects of allogeneic blood transfusions: clinical manifestations and mechanisms Vox Sang 74(Suppl 2) 315–9
MJ Dallman KJ Wood PJ Morris (1987) ArticleTitleSpecific cytotoxic T cells are not found in the non-rejected kidneys in blood transfused rats J Exp Med 173 433–8
G Opelz PI Terasaki (1980) ArticleTitleDominant effect of transfusions on kidney graft survival Transplantation 29 153–8 Occurrence Handle1:STN:280:DyaL3c7isFSlsA%3D%3D Occurrence Handle6986688 Occurrence Handle10.1097/00007890-198002000-00013
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Nakafusa, Y., Tanaka, T., Tanaka, M. et al. 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, 2055–2063 (2004). https://doi.org/10.1007/s10350-004-0716-7
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DOI: https://doi.org/10.1007/s10350-004-0716-7