title: Aggressive surgical treatment for patients with T4 rectal cancer.
abstract: OBJECTIVE
  To investigate the outcome of surgical treatment for patients with T4 rectal cancer and to evaluate prognostic factors influencing 5-year disease-free survival.
  
  
  METHODS
  Of 1600 rectal cancers seen between 1985 and 1998, there were 197 patients with T4 of whom 128 were treated with curative intent. In this retrospective study organ invaded, the type of treatment and outcome were analysed.
  
  
  RESULTS
  Of the 128 patients, 89% had visceral involvement and 11% had pelvic wall involvement. The most frequently involved organ was bladder, followed by prostate and vagina. Low anterior resection was performed in 52, abdomino-perineal resection in 35 and total pelvic exenteration in 41 patients. Of 81 with urinary tract invasion, 50% were treated with bladder-sparing surgery. Pathological examinations showed bladder involvement in only 44 of these and overall 5-year disease-free survival was 57%. Multivariate analysis revealed that body mass index, lymph node metastasis and inflammatory reaction were significant predictors of survival.
  
  
  CONCLUSIONS
  Completeness of resection is the essential factor influencing oncological outcome.
authors.affiliation: Colorectal Surgical Unit, National Cancer Centre Hospital, Tsukiji 5-1-1, Chuo-Ku, Tokyo 104-0045, Japan. ymoriya@ncc.go.jp
authors.forename: Y
authors.initials: Y
authors.lastname: Moriya
authors.forename: T
authors.initials: T
authors.lastname: Akasu
authors.forename: S
authors.initials: S
authors.lastname: Fujita
authors.forename: S
authors.initials: S
authors.lastname: Yamamoto
mesh_terms: D000328:Adult; D000368:Aged; D016009:Chi-Square Distribution; D018572:Disease-Free Survival; D005260:Female; D006801:Humans; D008197:Lymph Node Excision; D008297:Male; D008875:Middle Aged; D009361:Neoplasm Invasiveness; D009362:Neoplasm Metastasis; D009367:Neoplasm Staging; D010385:Pelvic Exenteration; D011183:Postoperative Complications; D011379:Prognosis; D016016:Proportional Hazards Models; D012004:Rectal Neoplasms / Q000473:pathology / Q000601:surgery*; D012189:Retrospective Studies; D016896:Treatment Outcome