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Prognostic factors affecting outcomes in multivisceral en bloc resection for colorectal cancer.
- Source :
-
Clinics (Sao Paulo, Brazil) [Clinics (Sao Paulo)] 2017 May; Vol. 72 (5), pp. 258-264. - Publication Year :
- 2017
-
Abstract
- Objectives:: This study sought to determine the clinical and pathological factors associated with perioperative morbidity, mortality and oncological outcomes after multivisceral en bloc resection in patients with colorectal cancer.<br />Methods:: Between January 2009 and February 2014, 105 patients with primary colorectal cancer selected for multivisceral resection were identified from a prospective database. Clinical and pathological factors, perioperative morbidity and mortality and outcomes were obtained from medical records. Estimated local recurrence and overall survival were compared using the log-rank method, and Cox regression analysis was used to determine the independence of the studied parameters. ClinicalTrials.gov: NCT02859155.<br />Results:: The median age of the patients was 60 (range 23-86) years, 66.7% were female, 80% of tumors were located in the rectum, 11.4% had stage-IV disease, and 54.3% received neoadjuvant chemoradiotherapy. The organs most frequently resected were ovaries and annexes (37%). Additionally, 30.5% of patients received abdominoperineal resection. Invasion of other organs was confirmed histologically in 53.5% of patients, and R0 resection was obtained in 72% of patients. The overall morbidity rate of patients in this study was 37.1%. Ureter resection and intraoperative blood transfusion were independently associated with an increased number of complications. The 30-day postoperative mortality rate was 1.9%. After 27 (range 5-57) months of follow-up, the mortality and local recurrence rates were 23% and 15%, respectively. Positive margins were associated with a higher recurrence rate. Positive margins, lymph node involvement, stage III/IV disease, and stage IV disease alone were associated with lower overall survival rates. On multivariate analysis, the only factor associated with reduced survival was lymph node involvement.<br />Conclusions:: Multivisceral en bloc resection for primary colorectal cancer can be performed with acceptable rates of morbidity and mortality and may lead to favorable oncological outcomes.
- Subjects :
- Adult
Aged
Aged, 80 and over
Colorectal Neoplasms pathology
Female
Humans
Intraoperative Complications
Kaplan-Meier Estimate
Male
Middle Aged
Morbidity
Neoadjuvant Therapy
Neoplasm Invasiveness
Neoplasm Recurrence, Local
Neoplasm Staging
Postoperative Complications
Prognosis
Prospective Studies
Risk Factors
Time Factors
Viscera pathology
Viscera surgery
Young Adult
Colorectal Neoplasms mortality
Colorectal Neoplasms surgery
Subjects
Details
- Language :
- English
- ISSN :
- 1980-5322
- Volume :
- 72
- Issue :
- 5
- Database :
- MEDLINE
- Journal :
- Clinics (Sao Paulo, Brazil)
- Publication Type :
- Academic Journal
- Accession number :
- 28591336
- Full Text :
- https://doi.org/10.6061/clinics/2017(05)01