Multivisceral resections for rectal cancers: short-term oncological and clinical outcomes from a tertiary-care center in India.
BACKGROUND
Locally advanced rectal cancers (LARCs) involve one or more of the adjacent organs in upto 10-20% patients. The cause of the adhesions may be inflammatory or neoplastic, and the exact causes cannot be determined pre- or intra-operatively. To achieve complete resection, partial or total mesorectal excision (TME) en bloc with the involved organs is essential. The primary objective of this study is to determine short-term oncological and clinical outcomes in these patients undergoing multivisceral resections (MVRs).


METHODS
This is a retrospective review of a prospectively maintained database. Between 1 July 2013 and 31 May 2015, all patients undergoing MVRs for adenocarcinoma of the rectum were identified from this database. All patients who had en bloc resection of an adjacent organ or part of an adjacent organ were included. Those with unresectable metastatic disease after neoadjuvant therapy were excluded.


RESULTS
Fifty-four patients were included in the study. Median age of the patients was 43 years. Mucinous histology was detected in 29.6% patients, and signet ring cell adenocarcinoma was found in 24.1% patients. Neoadjuvant therapy was given in 83.4% patients. R0 resection was achieved in 87% patients. Five-year overall survival (OS) was 70% for the entire cohort of population.


CONCLUSIONS
In Indian subcontinent, MVRs in young patients with high proportion of signet ring cell adenocarcinomas based on magnetic resonance imaging (MRI) of response assessment (MRI 2) is associated with similar circumferential resection margin (CRM) involvement and similar adjacent organ involvement as the western patients who are older and surgery is being planned on MRI 1 (baseline pelvis). However, longer follow-up is needed to confirm noninferiority of oncological outcomes.
1 Department of Surgical Oncology, 2 Department of Medical Oncology, 3 Department of Radiation Oncology, 4 Department of Radiodiagnosis, 5 Department of Digestive Diseases and Clinical Nutrition, 6 Department of Pathology, Tata Memorial Centre, Mumbai, Maharashtra, India.
Vishwas D
VD
Pai
1 Department of Surgical Oncology, 2 Department of Medical Oncology, 3 Department of Radiation Oncology, 4 Department of Radiodiagnosis, 5 Department of Digestive Diseases and Clinical Nutrition, 6 Department of Pathology, Tata Memorial Centre, Mumbai, Maharashtra, India.
Sudhir
S
Jatal
1 Department of Surgical Oncology, 2 Department of Medical Oncology, 3 Department of Radiation Oncology, 4 Department of Radiodiagnosis, 5 Department of Digestive Diseases and Clinical Nutrition, 6 Department of Pathology, Tata Memorial Centre, Mumbai, Maharashtra, India.
Vikas
V
Ostwal
1 Department of Surgical Oncology, 2 Department of Medical Oncology, 3 Department of Radiation Oncology, 4 Department of Radiodiagnosis, 5 Department of Digestive Diseases and Clinical Nutrition, 6 Department of Pathology, Tata Memorial Centre, Mumbai, Maharashtra, India.
Reena
R
Engineer
1 Department of Surgical Oncology, 2 Department of Medical Oncology, 3 Department of Radiation Oncology, 4 Department of Radiodiagnosis, 5 Department of Digestive Diseases and Clinical Nutrition, 6 Department of Pathology, Tata Memorial Centre, Mumbai, Maharashtra, India.
Supreeta
S
Arya
1 Department of Surgical Oncology, 2 Department of Medical Oncology, 3 Department of Radiation Oncology, 4 Department of Radiodiagnosis, 5 Department of Digestive Diseases and Clinical Nutrition, 6 Department of Pathology, Tata Memorial Centre, Mumbai, Maharashtra, India.
Prachi
P
Patil
1 Department of Surgical Oncology, 2 Department of Medical Oncology, 3 Department of Radiation Oncology, 4 Department of Radiodiagnosis, 5 Department of Digestive Diseases and Clinical Nutrition, 6 Department of Pathology, Tata Memorial Centre, Mumbai, Maharashtra, India.
Munita
M
Bal
1 Department of Surgical Oncology, 2 Department of Medical Oncology, 3 Department of Radiation Oncology, 4 Department of Radiodiagnosis, 5 Department of Digestive Diseases and Clinical Nutrition, 6 Department of Pathology, Tata Memorial Centre, Mumbai, Maharashtra, India.
Avanish P
AP
Saklani
Multivisceral resections (MVRs); oncological outcomes; rectal carcinoma