This is the Scientific Surgery Archive, which contains all randomized clinical trials in surgery that have been identified by searching the top 50 English language medical journal issues since January 1998. Compiled by Jonothan J. Earnshaw, former Editor-in-Chief, BJS
Multivisceral resection for primary locally advanced rectal carcinoma. BJS 2011; 98: 582-588.
Published: 24th December 2010
Authors: D. A. Harris, M. Davies, M. G. Lucas, P. Drew, N. D. Carr, J. Beynon et al.
Background
Pelvic multivisceral resection offers the possibility of cure in patients with locally advanced rectal cancer. This study assessed the clinical outcome and determinants of survival and local recurrence in patients undergoing multivisceral resection for clinical T4 primary rectal cancer.
Method
This was a cohort study of consecutive multivisceral resections carried out in a single centre from 2000 to 2009. Determinants of local recurrence and survival were examined by means of Kaplan–Meier survival curves and Cox regression analysis.
Results
The study included 42 patients, with a median age of 62 (range 41–83) years, who underwent surgery with a median follow‐up of 30 (range 2–102) months. Thirty‐one patients had preoperative chemoradiotherapy. Seven patients had rectal resection with en bloc radical prostatectomy. The 30‐day mortality rate was zero. Thirty‐nine of the 42 patients had a negative circumferential resection margin. The 5‐year overall survival rate for those who had complete resection was 48 per cent. Local recurrence was predicted by metastatic disease (P < 0·001) and nodal disease (P < 0·001), but not positive resection margins (P = 0·077).
Conclusion
An aggressive surgical strategy with complete resection is predictive of long‐term survival in selected patients with T4a rectal carcinoma. With optimal treatment local recurrence is a sign of systemic disease. Copyright © 2010 British Journal of Surgery Society Ltd. Published by John Wiley & Sons, Ltd.
Full text