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Open Access 01-09-2020 | Colon Cancer | Original Article

Subclassification of Multivisceral Resections for T4b Colon Cancer with Relevance for Postoperative Complications and Oncological Risks

Authors: Karin A. T. G. M. Wasmann, Charlotte E. L. Klaver, Jarmila D. W. van der Bilt, Iris D. Nagtegaal, Albert M. Wolthuis, Hjalmar C. van Santvoort, Bert Ramshorst, André D’Hoore, Johannes H. W. de Wilt, Pieter J. Tanis

Published in: Journal of Gastrointestinal Surgery | Issue 9/2020

Abstract

Background

Multivisceral resection for T4b colon cancer constitutes a heterogeneous group of surgical procedures. The purpose of this study was to explore clinically distinct categories of multivisceral resection, with subsequent correlation to postoperative complications and oncological outcomes.

Methods

In this multicenter cohort study, all consecutive patients without metastases who underwent multivisceral resection for pT4bN0-2M0 colon cancer between 2000 and 2014 were included. Multivisceral resection was divided into four categories: (i) gastrointestinal (including the stomach), (ii) urologic ((partial) bladder and ureter), (iii) solid organ (spleen, kidney, liver, pancreas, and uterus), and (iv) abdominal wall/omentum/ovaries. The primary outcome was surgical complications and secondary outcomes were 5-year intra-abdominal recurrence, disease-free survival, and overall survival.

Results

In total, 130 patients who underwent curative intent resection of pT4 colon cancer were included. Patients who underwent multivisceral resection within multiple categories were assigned to one of the categories based on hierarchy of clinical impact after exploratory analysis. For the primary endpoint, 55 patients were assigned to gastrointestinal, 14 to urologic, 14 to solid organ, and 47 to abdominal wall/omentum/ovaries multivisceral resection. Gastrointestinal multivisceral resection was independently associated with surgical complications (HR 3.9, 95% CI 1.4–10.6). Abdominal wall/omentum/ovaries multivisceral resection was significantly related with intra-abdominal recurrence (HR 7.8, 95% CI 1.0–57.8). The 5-year disease-free survival and overall survival showed no significant differences per multivisceral resection category.

Conclusions

Multivisceral resections for T4b colon cancer are heterogeneous procedures considering risk profiles. The proposed multivisceral resection subclassification needs validation, but might improve comparability between studies and hospitals (auditing).

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Title: Subclassification of Multivisceral Resections for T4b Colon Cancer with Relevance for Postoperative Complications and Oncological Risks
Authors: Karin A. T. G. M. Wasmann
Charlotte E. L. Klaver
Jarmila D. W. van der Bilt
Iris D. Nagtegaal
Albert M. Wolthuis
Hjalmar C. van Santvoort
Bert Ramshorst
André D’Hoore
Johannes H. W. de Wilt
Pieter J. Tanis
Publication date: 01-09-2020
Publisher: Springer US
Keywords: Colon Cancer
Colon Cancer
Published in: Journal of Gastrointestinal Surgery / Issue 9/2020
Print ISSN: 1091-255X
Electronic ISSN: 1873-4626
DOI: https://doi.org/10.1007/s11605-019-04426-3

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Subclassification of Multivisceral Resections for T4b Colon Cancer with Relevance for Postoperative Complications and Oncological Risks

Abstract

Background

Methods

Results

Conclusions

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Abstract

Background

Methods

Results

Conclusions

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