title: Locally advanced colorectal cancer: results of surgical treatment and prognostic factors.
abstract: OBJECTIVE
  To evaluate the incidence surgical results and prognostic factors of locally advanced colorectal cancer.
  
  
  METHODS
  Cohort study including 679 colorectal cancer patients treated from 1997 to 2007. Clinical, surgical and histological data were analyzed.
  
  
  RESULTS
  Ninety patients (females 61%; median age 59 years) were treated for locally advanced carcinomas (13.2%), either in the colon (66%) or rectum (34%). Extended resections most commonly involved the small bowel (19.8%), bladder (16.4%), uterus (12.9%) and ovaries (11.2%). Postoperative morbidity and mortality occurred in 23 (25.6%) and 3 (3.3%) patients, respectively. Survival and recurrence analysis among 76 R0 (84.4%) procedures revealed a 60% 5-year survival and 34% local recurrence rates. Survival curves demonstrated reduced rates for rectal location (45% vs 65%), tumor depth (50% for T4 vs 75% for T3), vascular/ lymphatic/perineural invasion (35% vs 80%) and lymph node metastasis (35% vs 80%).
  
  
  CONCLUSIONS
  Locally advanced carcinomas were found in 13.2% of patients. Survival rates were negatively affected by rectal location and adverse histological features. Number of involved organs and neoplastic adhesions did not influenced chances of survival. A radical R0 extended resection was achieved in a high proportion of cases, resulting in a 60% cancer-free survival under acceptable operative risks.
authors.affiliation: Unidade Colorretal, Hospital das Clínicas, Faculdade de Medicina, Universidade de São Paulo. fgmcampos@terra.com.br
authors.forename: Fábio Guilherme
authors.initials: FG
authors.lastname: Campos
authors.forename: Maria Célia
authors.initials: MC
authors.lastname: Calijuri-Hamra
authors.forename: Antonio Rocco
authors.initials: AR
authors.lastname: Imperiale
authors.forename: Desidério Roberto
authors.initials: DR
authors.lastname: Kiss
authors.forename: Sergio Carlos
authors.initials: SC
authors.lastname: Nahas
authors.forename: Ivan
authors.initials: I
authors.lastname: Cecconello
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D003110:Colonic Neoplasms / Q000401:mortality / Q000473:pathology / Q000601:surgery*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009361:Neoplasm Invasiveness; D009364:Neoplasm Recurrence, Local; D009367:Neoplasm Staging; D011183:Postoperative Complications; D011379:Prognosis; D011446:Prospective Studies; D012004:Rectal Neoplasms / Q000401:mortality / Q000473:pathology / Q000601:surgery*; D016019:Survival Analysis; D055815:Young Adult