title: Multivisceral resection for T4 or recurrent colorectal cancer.
abstract: BACKGROUND
  Approximately 10% of patients with colorectal cancer have locally advanced disease with peritoneal involvement (T4a) or invasion of adjacent organs (T4b) at the time of diagnosis. Of patients who undergo resection with curative intent, between 7 and 33% develop isolated locoregional recurrences. R0 surgical excision is potentially curative.
  
  
  METHODS
  We reviewed the literature relating to multivisceral resection for T4 or recurrent colorectal cancer.
  
  
  RESULTS
  Comprehensive staging to identify the local and systemic extent of disease is essential to determine resectability and patient suitability for a curative approach. PET scans and pelvic MRI (rectal) staging and a coordinated multispecialty input to neoadjuvant treatment, multivisceral surgical resection, reconstruction and adjuvant chemotherapy are essential. Intraoperative radiotherapy and hyperthermic intraperitoneal chemotherapy may have a role in selected patients. R0 resection can achieve 5-year local control rates for primary locally advanced and recurrent colorectal cancer of up to 89 and 38%, respectively, and overall 5-year survival up to 66 and 25%, respectively.
  
  
  CONCLUSIONS
  An aggressive surgical strategy as part of a multimodal strategy in the treatment of locally advanced or recurrent colorectal cancer in the absence of incurable metastatic disease affords the best prospect for long-term survival in selected patients.
authors.affiliation: Surgical Professorial Unit, St. Vincent's University Hospital and UCD School of Medicine and Medical Sciences, Dublin, Ireland.
authors.forename: J O
authors.initials: JO
authors.lastname: Larkin
authors.forename: P R
authors.initials: PR
authors.lastname: O'Connell
mesh_terms: D003110:Colonic Neoplasms / Q000473:pathology* / Q000601:surgery* / Q000628:therapy; D006801:Humans; D020360:Neoadjuvant Therapy; D009364:Neoplasm Recurrence, Local / Q000601:surgery* / Q000628:therapy; D009367:Neoplasm Staging; D012004:Rectal Neoplasms / Q000473:pathology* / Q000601:surgery* / Q000628:therapy