title: Multivisceral Resection for Locally Advanced Rectal Cancer: Prognostic Factors Influencing Outcome.
abstract: OBJECTIVE
  To assess outcome in patients with locally advanced rectal cancer undergoing multivisceral resection.
  
  
  METHODS
  Retrospective study of 30 consecutive patients (mean age 67.8 years) with primary locally advanced rectal cancer undergoing en bloc multivisceral resection of the organs involved with curative intent between 1998 and 2010. Overall survival, local and distal recurrence, and disease-free survival were analyzed by the Kaplan-Meier method. Risk factors for clinical outcome were obtained using a Cox multivariate model.
  
  
  RESULTS
  Postoperative complications occurred in 76.7% of patients and the in-hospital mortality rate was 10%. The median follow-up was 28.8 months. A total of 19 patients died at follow-up. Of the 11 patients who were alive, 7 were free of disease. In the multivariate analysis, lymph node involvement, stage II, and lymph vascular invasion were significantly associated with survival, and stage III showed a strong trend towards significance. Suture dehiscence (peritonitis and intra-abdominal abscess) showed a significant trend towards a higher local recurrence. Lymph vascular invasion was associated with a higher distant recurrence.
  
  
  CONCLUSIONS
  Lymph node involvement was associated with worse survival, whereas stage II and absence of lymph vascular invasion were associated with a better survival. Lymph vascular invasion was associated with a higher distant recurrence.
authors.affiliation: Colorectal Surgery Unit, General Surgery Service, Department of Surgery, Hospital Universitari Vall d'Hebron, Universitat Autónoma de Barcelona, Barcelona, Spain mjmanas@hotmail.com.
authors.forename: M J
authors.initials: MJ
authors.lastname: Mañas
authors.affiliation: Colorectal Surgery Unit, General Surgery Service, Department of Surgery, Hospital Universitari Vall d'Hebron, Universitat Autónoma de Barcelona, Barcelona, Spain.
authors.forename: E
authors.initials: E
authors.lastname: Espín
authors.affiliation: Colorectal Surgery Unit, General Surgery Service, Department of Surgery, Hospital Universitari Vall d'Hebron, Universitat Autónoma de Barcelona, Barcelona, Spain.
authors.forename: M
authors.initials: M
authors.lastname: López-Cano
authors.affiliation: Colorectal Surgery Unit, General Surgery Service, Department of Surgery, Hospital Universitari Vall d'Hebron, Universitat Autónoma de Barcelona, Barcelona, Spain.
authors.forename: F
authors.initials: F
authors.lastname: Vallribera
authors.affiliation: Colorectal Surgery Unit, General Surgery Service, Department of Surgery, Hospital Universitari Vall d'Hebron, Universitat Autónoma de Barcelona, Barcelona, Spain.
authors.forename: M
authors.initials: M
authors.lastname: Armengol-Carrasco
mesh_terms: D000368:Aged; D002277:Carcinoma / Q000401:mortality / Q000473:pathology* / Q000601:surgery*; D018572:Disease-Free Survival; D005260:Female; D006801:Humans; D053208:Kaplan-Meier Estimate; D008297:Male; D009361:Neoplasm Invasiveness; D009367:Neoplasm Staging; D012004:Rectal Neoplasms / Q000401:mortality / Q000473:pathology* / Q000601:surgery*; D012189:Retrospective Studies; D016896:Treatment Outcome
keywords: Multivisceral resection; locally advanced; locoregional recurrence; prognostic factors; rectal cancer; survival