EXTENDED RESECTION FOR LOCALLY ADVANCED COLORECTAL-CARCINOMA

Background: The purpose of this study was to determine the therapeutic benefit of multivisceral resection (MVR) in patients with locally adv anced colorectal carcinomas. Methods: The study population was compose d of 118 patients whose resection of the primary lesion included one o r more adhesed adjacent secondary organs or structures (ASOS). Tumors were staged as B3 (T4,N0) and as C3 (T4,N1-3). Adhesions were classifi ed as invasive (B3+,C3+) or inflammatory (B3-,C3-). Results: Sixty-fou r patients were staged B3 and 54 C3. Eighty-one were classified B3+/C3 +. Fifty-nine percent of patients had ASOS resected, 29% had two resec ted, and the remaining 12% had three or four resected. Actuarial 5-yea r survival rates were 62% and 38% (p = 0.017) for B3 and C3 lesions, r espectively. The 5-year survival rates were 78% for patients with B3- tumors and 58% for those with B3+ tumors (p = 0.043), and 34% for pati ents with C3+ tumors and 64% for those with C3- tumors (p = NS), The 5 -year survival rates were 71% for patients with B3-/C3- tumors and 47% for those with B3+/C3+ tumors (p = NS). The 5-year survival rates aft er resection of one ASOS, two ASOS, and three or four ASOS were 52%, 5 5%, and 38%, respectively (p = NS). Conclusion: There is no statistica lly significant difference in the 5-year survival rates when multiple ASOS are resected; therefore, an aggressive surgical approach is warra nted.