title: Multivisceral resection for primary locally advanced rectal carcinoma.
abstract: BACKGROUND
  Pelvic multivisceral resection offers the possibility of cure in patients with locally advanced rectal cancer. This study assessed the clinical outcome and determinants of survival and local recurrence in patients undergoing multivisceral resection for clinical T4 primary rectal cancer.
  
  
  METHODS
  This was a cohort study of consecutive multivisceral resections carried out in a single centre from 2000 to 2009. Determinants of local recurrence and survival were examined by means of Kaplan-Meier survival curves and Cox regression analysis.
  
  
  RESULTS
  The study included 42 patients, with a median age of 62 (range 41-83) years, who underwent surgery with a median follow-up of 30 (range 2-102) months. Thirty-one patients had preoperative chemoradiotherapy. Seven patients had rectal resection with en bloc radical prostatectomy. The 30-day mortality rate was zero. Thirty-nine of the 42 patients had a negative circumferential resection margin. The 5-year overall survival rate for those who had complete resection was 48 per cent. Local recurrence was predicted by metastatic disease (P < 0.001) and nodal disease (P < 0.001), but not positive resection margins (P = 0.077).
  
  
  CONCLUSIONS
  An aggressive surgical strategy with complete resection is predictive of long-term survival in selected patients with T4a rectal carcinoma. With optimal treatment local recurrence is a sign of systemic disease.
authors.affiliation: Abertawe Bro Morgannwg University Local Health Board, Swansea, UK. dean.harris2@wales.nhs.uk
authors.forename: D A
authors.initials: DA
authors.lastname: Harris
authors.forename: M
authors.initials: M
authors.lastname: Davies
authors.forename: M G
authors.initials: MG
authors.lastname: Lucas
authors.forename: P
authors.initials: P
authors.lastname: Drew
authors.forename: N D
authors.initials: ND
authors.lastname: Carr
authors.forename: J
authors.initials: J
authors.lastname: Beynon
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D017024:Chemotherapy, Adjuvant; D005260:Female; D006801:Humans; D053208:Kaplan-Meier Estimate; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local / Q000401:mortality; D018714:Radiotherapy, Adjuvant; D012004:Rectal Neoplasms / Q000401:mortality / Q000601:surgery*; D016896:Treatment Outcome; D014781:Viscera / Q000601:surgery*