Multivisceral ‘en-bloc` resections of colorectal tumours - milestones in the surgical techniques

Abstract

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

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