Standard and multivisceral colectomy in locally advanced colon cancer

Abstract

BACKGROUND: Management of locally advanced colon cancer (LACC) is challenging. Surgery is the mainstay of the treatment yet its outcomes remain unclear, especially in the setting of multivisceral resections. This study sought to examine the outcomes of colectomy in patients with LACC.

METHODS: Patients demographics, clinical and perioperative data of patients operated within study period (2004-2018) were collected. LACC was defined as stage T4 colon cancer including tumor invasion either through the visceral peritoneum or to the adjacent organs/structures. Accordingly, either standard or multivisceral colectomy (SC and MVC, respectively) was performed.

RESULTS: Two hundred and three patients underwent colectomy for LACC. Of those, 91 had SC (44.8%) and 122 (55.2%) had MVC. Severe morbidity and mortality rates were 7.4 and 2.5%, respectively. The majority of the patients with MVC underwent resection of ≥ 2 organs. MVC was associated with longer operative time (180 vs 140 min, p<0.01) and prolonged postoperative hospital stay (11 vs 10 days, p<0.01) compared with SC. The complication-associated parameters were similar. Male gender, presence of ≥ 3 comorbidities, tumor location in the left colon and perioperative blood transfusion were associated with complications in the univariable analysis. In the multivariable model, the presence of ≥ 3 comorbidities was the only independent predictor of complications.

CONCLUSION: Colectomy with or without multivisceral resection is a safe procedure in LACC. In experienced hands, the postoperative outcomes are similar for SC and MVC. Given the complexity of the latter, these procedures should be reserved to qualified expert centers.