G. Laurence1, R. Grim1, T. Bell1, N. Ahuja2 1York Hospital,York, PA, USA 2Johns Hopkins University School Of Medicine,Baltimore, MD, USA
Introduction: Multivisceral resection (MVR) is a radical, often controversial last-resort operation. However, when locally advanced colorectal cancers invade adjacent organs, MVR is an important consideration for select patients wanting to take aggressive action to increase survival. The current study addresses the outcomes of MVR in locally advanced recto-sigmoid cancer patients and hypothesizes that MVR improves survival compared to standard and no surgery.
Methods: SEER data (1988-2008) was used to identify patients with MVR. Patients were limited to single primary locally advanced non-metastatic colorectal cancers originating from the sigmoid and rectum. Surgery groupings were MVR, standard surgery (SS; low anterior and abdominoperineal resections), and no surgery (NS).
Results: The study included 4,111 (SS=60.7%, NS=23.2%, MVR=16.1%) locally advanced non-metastatic recto sigmoid cancer patients. Predictors of survival were female, radiation and MVR (Table 1). Kaplan Meier analysis showed that overall five-year survival was highest for MVR (43.1%), followed by SS (31.5%) and NS (9.7%), p<0.001. With radiation treatment, five-year survival improved for all groups, with the highest being MVR (47.8%), followed by SS (36.3%), and NS (14%), p<0.001. With no radiation treatment, five-year survival decreased for all groups, but remained the highest for MVR (35.3%), followed by SS (21.5%), and NS (2.3%, p<0.001).
Conclusion: While MVR is an extensive surgical procedure with significant morbidity that usually requires specialized training and coordination, the present study supports that MVR offers greater survival advantage in patients with locally advanced recto-sigmoid cancer.
