title: Results after multivisceral resections of locally advanced colorectal cancers: an analysis on clinical and pathological t4 tumors.
abstract: BACKGROUND
  Locally advanced colorectal cancers are best treated with multivisceral resections. The aim of this study is to evaluate early and late results after multivisceral resections.
  
  
  METHODS
  All patients operated for primary colorectal cancer between 2001 and 2010 were -reviewed. These were compared within the patients underwent single organ and multivisceral resections: demographics, tumor and procedure related parameters, perioperative results, early oncological outcomes and 5-year survival.
  
  
  RESULTS
  A total of 354 patients (59.6 ± 13.8 years old, 210 [59.3%] males) were abstracted. Ninety (25.4%) patients underwent multivisceral resections for clinical T4 tumors and en-bloc R0 resection was achieved in 82 (91.1%). Only 31 (34.4% and 8.8% of clinical T4 and all cancers, respectively) cases had actual adjacent organ invasions (pT4). Males (20%) had lower risk for locally advanced tumors than females (33.3%) (p < 0.05). PT4 cancers were more common, if the clinical T4 tumor is located in the colon (48.8% vs 21.3%; p < 0.01). Laparoscopy was seldom initiated and the risk of conversion was higher in clinical T4 tumors (p < 0.05). The rates of sphincter-saving procedures were not different. Operation time, bleeding and transfusion requirements increased when multivisceral resections were necessitated (p < 0.05), but hospital stay, complications and 30-day mortality rates were similar. The 5-year survival rates were identical (p > 0.05).
  
  
  CONCLUSIONS
  Clinical T4 tumors are not rare and more common in women. An actual invasion (pT4) may be observed in one third of all clinical T4 tumors, and more frequent in colon cancers. An en-bloc, R0, multivisceral resection may be achieved in most cases. Multivisceral resections do not alter the rates of sphincter-saving procedures, morbidity and 30-day mortality; do not worsen survival but increase operation time, intraoperative bleeding and perioperative transfusion requirements.
authors.affiliation: Department of General Surgery, Kartal Education and Research Hospital, Istanbul, Turkey. cemgezen@hotmail.com
authors.forename: Cem
authors.initials: C
authors.lastname: Gezen
authors.forename: Metin
authors.initials: M
authors.lastname: Kement
authors.forename: Yunus E
authors.initials: YE
authors.lastname: Altuntas
authors.forename: Nuri
authors.initials: N
authors.lastname: Okkabaz
authors.forename: Mesut
authors.initials: M
authors.lastname: Seker
authors.forename: Selahattin
authors.initials: S
authors.lastname: Vural
authors.forename: Mahmut
authors.initials: M
authors.lastname: Gumus
authors.forename: Mustafa
authors.initials: M
authors.lastname: Oncel
mesh_terms: D000230:Adenocarcinoma / Q000401:mortality / Q000556:secondary / Q000601:surgery; D015179:Colorectal Neoplasms / Q000401:mortality / Q000473:pathology* / Q000601:surgery*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008207:Lymphatic Metastasis; D008297:Male; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local / Q000401:mortality / Q000473:pathology / Q000601:surgery; D009367:Neoplasm Staging; D011183:Postoperative Complications; D011379:Prognosis; D011446:Prospective Studies; D015996:Survival Rate; D014781:Viscera / Q000473:pathology* / Q000601:surgery*