Multivisceral resections for primary advanced rectal cancer

Fixation of the locally advanced rectal tumor at the time of operation is a n important prognostic variable. It may be difficult to determine whether f ixation is caused by inflammatory adhesions or by direct tumor extension te thering the tumor to the surrounding pelvic structures. Extended en bloc re moval of the locally advanced rectal cancer with involved adjacent organ(s) increases the resectability rate. We examined the perioperative mortality and morbidity and the prognosis of patients undergoing multivisceral resect ions for advanced primary rectal cancers. Of 83 patients with rectal cancer s 20 (24%) had locally advanced tumors. Cases were di vided into Gunderson- Sosin stages Bg and Cg and were further stratified into those with histolog ically confirmed carcinomatous invasion of the adjacent organ and those wit h inflammatory adhesions. Perioperative mortality was 5%. Only five patient s (24%) showed histopathological confirmation of carcinomatous adhesion int o adjacent organ(s)/structure(s). Histological confirmation of contiguous t umor spread was higher in C-3 patients. There was no significant difference between patients with positive and negative histopathological confirmation of malignant spread in terms of survival rates. Multivisceral resections c an be performed safely for locally advanced rectal cancers with acceptable mortality and morbidity rates. The presence of local tumor extension does n ot mean incurability, and sound surgical judgement should dictate that in t he face of a tethered lesion one must extend the surgical intervention radi cally to resect any tumor en bloc.