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A Journal on Surgery
Indexed/Abstracted in: EMBASE, Scopus, Emerging Sources Citation Index
Chirurgia 1999 February;12(1):23-6
Extended resection for advanced colorectal carcinoma
Pandolfi U., Soffiantini G., Uberti R., Marchesi R., Pistorio A.
Background. The finding of a locally extensive colorectal cancer is an event that still occurs frequently and often only in intra-operative time. In these last years extended resections are getting more and more credit. This study is aimed to check statistical incidence of cases requiring extended resections and to analyze their short term and long term results, comparing them with a group of patients undergoing standard resections and with all those patients treated with palliative resection in the same period.
Methods. Between 1984 and 1994, 490 cases of colorectal carcinoma were treated at our Surgical Department: 331 (68%) patients with standard resection, 129 (26%) with palliative resection and 30 (6%) with extended resection, expecially when primary tumour was localized on the left colon and rectum (60%).
Results. Mortality rate after extended resection was 20% versus 5% after standard resections and 8% after palliative procedures. Morbidity was 53% versus 44 and 39% respectively, with a similar typology of complications for every group analyzed. Five years survival rate was 46% versus 58 and 4%, and the analysis, performed with the Kaplan-Meier method and compared through the log-rank test, shows no significant difference in survival between standard and extended resections (p=0.145). A statistical analysis was performed on those variables which could have some influence on the prognosis of patients treated with extended resection: presence of benign or malignant adhesions between primary tumour and adjacent organs; presence of lymphonodes invasion and presence of postoperative complications. Data emphasize that the most determinative variable was regional nodal involvement, with a relative risk=12.25 and a highly significant difference in comparison with Kaplan-Meier survival curves among N- and N+ patients (p=0.039).
Conclusions. Personal experience confirms that locally advanced colorectal cancer, which have not spread to distant metastasis, should be treated with extended resection, if patient is in adequate health.