Safety of Multivisceral Resection for Locally advanced Colorectal Cancer

Purpose: About 10% of colorectal cancers are known to have already invaded contiguous organs or had inflammatory adhesion to adjacent structures. Under such circumstances, combined resections of involved structures may be considered. The aims of this study were to investigate true incidence of cancer invasion and surgical outcomes in patients where a multivisceral resection was performed for locally advanced colorectal cancer. Methods: Nine hundreds two patients with colorectal cancer submitted to surgical treatment between March 2000 and December 2007 were reviewed retrospectively, and multivisceral resection was performed in 68 patients. We reviewed the clinicopathologic characteristics of multivisceral resections for locally advanced colorectal cancer. Results: The incidence of multivisceral resection was 7.5%. The positive predictive values of cancer invasion were 60.0% in CT and 57.1% in MRI. The rate of true cancer invasion in multivisceral resection was 46.4%. In TMN stage, stage ⅢB was the most common(27.9%) and followed by stage ⅢC(20.6%). Rectal cancer was 29 cases(42.6%), sigmoid colon cancer was 18 cases(26.4%). In combined resection, female reproductive organ were the most commonly involved organ(27.2%) and followed by small bowel(16.3%) and bladder(9.8%). In number of organs, one organ in the combined resection was 41 cases(60.3%) and there was 1 case in which 6 neighboring structure involved in combined resection. There was no postoperative death and complications in postoperative period occurred in 23.5% including wound infection, intestinal obstruction, and pneumonia. Conclusions: When adhesion to neighboring organ by primary colorectal cancer was found intraoperatively, multivisceral resection would be mandatory regardless of the preoperative assessment. Every effort to reduce postoperative complication may be necessary to justify multivisceral resection.