LONG-TERM SURVIVAL AFTER RESECTION OF LOC ALLY ADVANCED COLORECTAL CARCINOMAS (T4)

Between 1972 and 1990, 456 patients with locally advanced colorectal c arcinomas (tumor stage T4) were operated. In 187 cases the operation w as extended by multivisceral resection and in 269 patients a conventio nal resection was performed. The rate of curative R0-resections was 74 ,9 % for the extended resection group compared to 66,2 % for the conve ntional group. The postoperative mortality after extended resection wa s 4,9 % (2,9 % conventional resection). Analyses of long-term results showed a 5-year survival for all R0-resected cases of 52,1 % +/- 4,1. Further evaluation of additional lymph-node involvement in T4 colorect al tumors revealed significant differences in 5-year survival: 64,8 % T4N0; 27,9 % T4N1,2; 9,2 % T4N3 for conventional R0-resection and 59,9 % T4N0; 23,2 % T4N1,2; 6,6 % T4N3 for extended R0-resection. After cu rative resection (R0) the presence or absence of intraoperative tumor- cell dissemination could be identified as a significant prognostic fac tor. In all cases of T4 colorectal carcinomas - especially for N1-3 - an adjuvant treatment after conventional or extended R0-resection is r ecommended.