Surgical management of the urinary tract in patients with locally advanced colorectal cancer.
OBJECTIVE
To review cases of colorectal cancer requiring urologic management to clarify the role the urologist should play in the surgical procedures. A deterrent to radical surgery for advanced colorectal carcinoma with urinary involvement is the technical complexity and associated morbidity and mortality of this procedure.


METHODS
Thirty-six tumors in 35 patients, including 19 sigmoid cancers (Stage II, 17; Stage III, 2), 12 rectal cancers (Stage II, 11; Stage III, 1), and 5 local recurrences of colorectal carcinoma in the pelvis were reviewed. All tumors had invaded the bladder, prostate, or ureter. The demographic and clinical characteristics, type of operative procedure, and postoperative complications were analyzed.


RESULTS
Of the patients with a sigmoid tumor, partial cystectomy was performed in 15 patients who underwent a bladder-sparing procedure; an ileal conduit and ileal neobladder were created in 2 patients each who required cystectomy. Four patients with rectal cancer underwent a bladder-sparing procedure: partial cystectomy in 1, partial cystectomy with ileal ureter in 1, and prostatectomy in 2. The remaining 8 patients underwent cystectomy with the following types of reconstruction: colonic neobladder in 1, ileal neobladder in 4, Indiana pouch in 1, ileal conduit in 1, and ureterocutaneostomy in 1 patient. The bladder was spared in a greater percentage of patients with sigmoid cancer than in those with rectal cancer. The incidence of complications was greater in patients with rectal cancer and local recurrence than in those with sigmoid tumors. The complication rate was especially low in patients who underwent a bladder-sparing procedure (10.5%) compared with patients who required cystectomy (58.3%). The survival in patients with sigmoid cancer who underwent bladder-sparing surgery also was better than in those who underwent cystectomy.


CONCLUSIONS
The treatment of advanced colorectal cancer is best managed by a committed team that includes an experienced urologist. Urologists play a critical role in determining the surgical options and creating appropriate urinary diversions to achieve curative resection with the highest quality of life.
Fujisawa
Masato
M
Division of Urology, Department of Organs Therapeutics, Kobe University Graduate School of Medicine, Kobe, Japan.
Nakamura
Takeshi
T
Ohno
Masakazu
M
Miyazaki
Jiro
J
Arakawa
Soichi
S
Haraguchi
Takahiro
T
Yamanaka
Nozomu
N
Yao
Akihisa
A
Matsumoto
Osamu
O
Kuroda
Yoshikazu
Y
Kamidono
Sadao
S
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D015653:Cystectomy / Q000379:methods / Q000401:mortality; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009361:Neoplasm Invasiveness; D011183:Postoperative Complications; D011468:Prostatectomy; D011471:Prostatic Neoplasms / Q000401:mortality / Q000601:surgery*; D012004:Rectal Neoplasms / Q000401:mortality / Q000601:surgery*; D012189:Retrospective Studies; D012811:Sigmoid Neoplasms / Q000401:mortality / Q000601:surgery*; D015996:Survival Rate; D014523:Urethral Neoplasms / Q000401:mortality / Q000601:surgery*; D001749:Urinary Bladder Neoplasms / Q000401:mortality / Q000601:surgery*; D014547:Urinary Diversion / Q000379:methods* / Q000401:mortality