Multivisceral resection of advanced colorectal carcinoma

Background and aims: In about 10% of patients with carcinoma of the colorectum, the tumour has already invaded contiguous organs or else inflammatory tumorous adhesions involving neighbouring structures are found. In such a situation, the question arises whether one should perform a multivisceral resection, the usefulness of which in terms of surgical risk and late oncological results have been investigated in the present study. Patients and methods: A total of 173 patients with colorectal carcinoma who underwent a multivisceral resection during the period between 1984 and 1995 are reported. Excluded from the study were patients with recurrent tumour or distant metastases. Results: In the majority of cases (63%), the primary tumour originated in the sigmoid colon or rectum. In 102 patients, only a single neighbouring organ was additionally involved, while the remaining patients had involvement of two or more contiguous organs. In 140 patients, the resection was curative, while in the remaining patients an R1/2 situation presented. In the curative group, tumour infiltration was confirmed histologically in 55% of the cases, while in the remaining patients a peritumourous adhesion had mimicked tumour invasion. Postoperative surgical complications occurred in only 1.4% of the interventions, a figure identical to the incidence of complications seen with conventional limited operations. The same applied to the postoperative 30-day mortality rate of 3.6%. The 5-year survival rate of the overall group of patients undergoing multivisceral resection was 42%, that of the subgroup undergoing curative surgery was 51%, and that of the subgroup receiving only palliative resection was 0%. Calculation of the stage-related 5-year survival rates for Union Internationale Contra la Cancrum stage-II and stage-III tumours revealed figures of 58% and 43%, respectively. After non-extended resection, the respective survival rates were identical (60% and 41%). Conclusion: An identical surgical risk and survival rates for curative resection, equally as good as those seen with conventional, non-extended procedures, justify the liberal use of multivisceral resection in the surgical treatment of colorectal carcinomas directly invading neighbouring organs. Received: 4 August 1998 Accepted: 18 December 1998     

Die multiviszerale Resektion des fortgeschrittenen Magenkarzinoms

Zusammenfassung Berichtet wird über die operative Behandlung von 589 Patienten mit einem Magenkarzinom aus den Jahren 1985–1990. Entsprechend einer Resektionsquote von 71 % wurden 416 Patienten reseziert bzw. gastrektomiert (kurativ: n = 330, palliativ: n = 86). Bei 15% der resezierten Patienten (n = 61) war wegen Fernmetastasen oder T4-Tumoren eine multiviszerale Resektion erforderlich (43mal kurativ, 18ma1 palliativ). Komplikationsraten (27 zu 26%) und die 30-Tage-Letalität (5,2 zu 3,3%) waren in beiden Gruppen der kurativ und erweitert Resezierten gleich. Die Berechnung der 5-Jahres-Überlebensraten ergab für die kurativ resezierten Patienten ohne Erweiterung einen Wert von 48 % gegenüber 22% mit Erweiterung. Werden jedoch aus der ersten Gruppe nur die T3-Tumoren berücksichtigt, so ergibt sich eine identische Überlebenszeit von 21 %. Die Ergebnisse lassen den Schlu zu, da bei der gleichen Komplikations-und Letalitätsrate die kurative Resektion von T4-Tumoren gleiche Spätergebnisse wie die entsprechende Behandlung von T3-Tumoren erwarten lät.

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The multivisceral resection of advanced gastric cancer

From 1985 to 1990, 589 patients with gastric cancer were operated upon. Gastric resection was performed on 416 patients (71%); it was curative in 330 cases and palliative in 86 cases. Multivisceral resection was necessary in 61 patients (i.e. 15% of the resected patients) because of distant metastases or T4 tumors (curative: 43 cases — palliative: 18 cases). Compared to the group of curative resections without multivisceral extension, the complication rate (27% vs 26%) and 30-day lethality (5.2% vs 3.3 %) were similar, whereas the 5-year survival rate was lower (22% vs 48%). However, the survival rate (21 %) was nearly identical for T3 tumors in the group without multivisceral extension. These results show that curative gastric resections of T4 tumors lead to the same long-term results as resections of T3 tumors and the complication rate and lethality are equal.

     

局部进展期大肠癌的联合脏器切除术

目的　研究局部进展期大肠癌扩大切除术的安全性，评价疗效和适用范围。方法　回顾性研究了１９７８ ～１９９３ 年行联合脏器切除的局部进展期（ Ⅳ期－ 中国改良法分类） 大肠癌６５ 例，选择同时期非联合脏器切除的６５ 例Ⅲ期病例作配对研究，比较两组手术并发症、手术死亡率、肿瘤复发率、术后生存率。并分析联合脏器切除组内疗效与年龄、性别、病变位置、病理特征、淋巴结转移范围、是否放化疗的关系。结果　两组病例在手术并发症和死亡率方面差异无显著性，５ 年生存率Ⅳ期病例与Ⅲ期相比差异无显著性意义。联合脏器切除术疗效与肿瘤病理特征、淋巴结转移范围关系密切。结论　对局部进展期大肠癌行联合脏器切除术是安全可行的，对提高病人生存率有肯定作用。对分化高的病例行此手术确保肿瘤完整切除尤为必要。     

Extended resection for locally advanced colorectal carcinoma

Background: The purpose of this study was to determine the therapeutic benefit of multivisceral resection (MVR) in patients with locally advanced colorectal carcinomas. Methods: The study population was composed of 118 patients whose resection of the primary lesion included one or more adhesed adjacent secondary organs or structures (ASOS). Tumors were staged as B3 (T4,N0) and as C3 (T4,N1–3). Adhesions were classified as invasive (B3+,C3+) or inflammatory (B3–,C3–). Results: Sixty-four patients were staged B3 and 54 C3. Eighty-one were classified B3+/C3+. Fifty-nine percent of patients had ASOS resected, 29% had two resected, and the remaining 12% had three or four resected. Actuarial 5-year survival rates were 62% and 38% (p=0.017) for B3 and C3 lesions, respectively. The 5-year survival rates were 78% for patients with B3– tumors and 58% for those with B3+ tumors (p=0.043), and 34% for patients with C3+ tumors and 64% for those with C3– tumors (p=NS). The 5-year survival rates were 71% for patients with B3–/C3– tumors and 47% for those with B3+/C3+ tumors (p=NS). The 5-year survival rates after resection of one ASOS, two ASOS, and three or four ASOS were 52%, 55%, and 38%, respectively (p=NS). Conclusion: There is no statistically significant difference in the 5-year survival rates when multiple ASOS are resected; therefore, an aggressive surgical approach is warranted.Presented at the 49th Annual Cancer Symposium of The Society of Surgical Oncology, Atlanta, Georgia, March 21–24, 1996.     

局部侵犯期结直肠癌扩大切除术66例的疗效分析

目的探讨局部侵犯期结直肠癌扩大切除术的疗效。方法回顾性分析1995年1月至2002年12月960例结直肠癌手术病例的临床资料,统计局部侵犯期结直肠癌的手术并发症率、围手术期死亡率、5年生存率,并用Cox回归方法对预后因素进行分析。结果局部侵犯期结直肠癌扩大切除术66例,占6.9%(66/960),手术并发症发生率27%(18/66),较结直肠癌常规手术高(χ2=8.82,P=0.002),围手术期死亡率为0。术后病理证实联合切除脏器的肿瘤侵犯率为31%(27/88),术后5年生存率为62%;联合切除脏器的粘连性质(Wald=7.42,P=0.005)、淋巴结状态(Wald=4.55,P=0.035)是影响预后的独立因素。结论局部侵犯期结直肠癌扩大切除术有较好的术后生存率,其手术并发症较常规手术高,但仍是安全术式。     

联合脏器切除治疗局部进展期结肠癌

目的探讨对局部进展期结肠癌患者行联合脏器切除的疗效及影响预后的因素。方法回顾性分析1988～1998年对47例结肠癌患者进行联合脏器切除治疗的临床资料,对其肿瘤复发模式及患者生存率进行统计分析。结果本组患者有7例(14.9%)术后出现并发症,无死亡病例。病理证实周围组织器官有肿瘤侵犯30例(63.8%);局部复发8例(17.0%),远处转移16例(34.0%);5年生存率为40.4%。多因素分析,肿瘤UICC分期及淋巴结转移是影响预后的重要因素(P<0.05)。结论对于局部进展期结肠癌累及周围组织脏器的患者,应力争联合脏器切除治疗。     

Resektion von lebermetastasen kolorektaler tumoren

Zusammenfassung In der Klinik für Allgemein- und Abdominalchirurgie der Johannes-Gutenberg-Universität Mainz wurden in der Zeit von September 1985 bis Dezember 1994 76 Patienten mit Metastasen kolorektaler Primärtumoren unter kurativer Zielsetzung an der Leber reseziert. Die 30-Tage-Letalität und die Komplikationsrate betrugen 6,6 und 30,3%. Die 3- und 5-Jahres-Überlebens-wahrscheinlichkeit nach Lebermetastasenresektion lagen bei 53 und 36%. Innerhalb der Patienten mit R0-Resektion (ohne Letalität) hatten bein univariater Analyse folgende Faktoren einen günstigen Einflu\ auf dieÜberlebens-wahrscheinlichkeit: N1-Klassifikation des Primärtumors im Vergleich zu N2 (bei Patienten mit mesenterialem Lymphknotenbefall), Durchmesser der grö\ten Lebermetastase von 2,1–3,5 cm, ein postoperative normalisierter CEA-Serumspiegel (jeweils bei Patienten mit präoperativ auf > 4 ng/ml erhöhtem CEA-Serumspiegel) und periphere Leberresektionen und Segmentresektionen im Vergleich zu Hemihepatektomien. Auf dasrezidivfreie Überleben hatten nur die N-Klassifikation des Primärtumors N1 im Vergleich zu N2 (bei Patienten mit mesenterialem Lymph-knotenbefall) und der Durchmesser der grö\ten Lebermetastase von 2,1–3,5 cm einen günstigen Einflu\. In der multivariaten Analyse war der Durchmesser der grö\ten Lebermetastase (2,1–3,5 cm am günstigsten) der einzige unabhängige Faktor für dieÜberlebenswahrscheinlichkeit, während in bezug auf dierezidivfreie Überlebens-wahrscheinlichkeit neben dem. Metastasendurchmesser auch das Patientengeschlecht (weiblich besser als männlich) und die N-Klassifikation des Primärtumors (N1 besser als N2) als unabhängige Prognosefaktoren bestätigt wurden. Inwieweit adjuvante Therapiema\nahmen (systemische oder regionale Chemotherapie) nach Metastasen-resektion eine Verbesserung der Prognose nach Leberresektion bewirken können, mu\ z.Z. noch offen bleiben. Jedoch könnten die oben genannten Prognosefaktoren z.T. für die Auswahl von Patienten, die in Studien zur post-operativen adjuvanten Chemotherapie eingebracht werden sollen, hilfreich sein.

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Resection of hepatic metastases from colorectal tumors: uni- and multivariate analysis of prognostic factors

Between September 1985 and December 1994, liver resections with curative intent were performed for liver metastases of colorectal primaries in 76 patients at the department for abdominal surgery of the university of Mainz. Perioperative morbidity and 30-day mortality rates were 30.3% and 6.6% respectively. The 3- and 5-year survival rate was 53% and 36% respectively. For patients with complete tumor removal (RO resection), excluding perioperative mortality, the following factors were associated with more prolonged survival after hepatic resection in univariate analysis. N1 stage of the colorectal primary compared to N2 stage (in patients with positive mesenterial lymph nodes); diameter of the largest metastasis between 2.1 and 3.5 cm; postoperative normalized CEA level (in patients with CEA level elevated to more than 4 ng/dl preoperatively); and wedge resections compared to hemihepatectomies. Regarding disease-free survival, only N1 stage of the colorectal primary compared to N2 stage and diameter of the largest metastasis between 2.1 and 3.5 cm had a positive influence. In multivariate analysis, the diameter of the largest metastasis was the only factor associated with survival time, while disease-free survival was influenced by the largest diameter of the metastasis, patient sex and N stage of the colorectal primary. Whether adjuvant therapies (systemic or regional chemotherapy) after curative resection of colorectal liver metastases is associated with better survival times remains an open question. Some of the above-mentioned prognostic factors may be helpful in selecting patients for entry into adjuvant therapy protocols.

     

Multivisceral resection for locally advanced gastric cancer: A retrospective study

BackgroundMultivisceral resection may be the exclusive radical procedure for cT4b gastric cancer patients. However, most surgeons refuse to select surgery because of the theoretical higher mortality, morbidity and poorer prognosis.MethodsWe retrospectively reviewed cT4b gastric cancer patients who underwent surgery from January 1,1997 to December 31,2018. The primary endpoint was overall survival. Short-term results and prognostic values of clinical and pathologic factors were also analyzed.ResultsPatients underwent multivisceral resection had an acceptable mortality and morbidity. The overall 5-year survival rate of multivisceral resection was higher than that of palliative surgery (P < 0.05). And independent prognostic factors of multivisceral resection were R+ resection, extensive lymph node involved (>15), vascular cancer emboli, and postoperative chemotherapy.Conclusions: cT4b gastric cancer patients underwent multivisceral resection experience acceptable mortality and morbidity. The independent prognostic factors for multivisceral resection were completeness of resection, extensive lymph node involvement (>15), vascular cancer emboli, and postoperative chemotherapy.     

From advanced diagnosis to advanced resection in early neoplastic colorectal lesions: Never-ending and trending topics in the 2020s

Colonoscopy represents the most widespread and effective tool for the prevention and treatment of early stage preneoplastic and neoplastic lesions in the panorama of cancer screening. In the world there are different approaches to the topic of colorectal cancer prevention and screening: different starting ages (45-50 years); different initial screening tools such as fecal occult blood with immunohistochemical or immune-enzymatic tests; recto-sigmoidoscopy; and colonoscopy. The key aspects of this scenario are composed of a proper bowel preparation that ensures a valid diagnostic examination, experienced endoscopist in detection of preneoplastic and early neoplastic lesions and open-minded to upcoming artificial intelligence-aided examination, knowledge in the field of resection of these lesions (from cold-snaring, through endoscopic mucosal resection and endoscopic submucosal dissection, up to advanced tools), and management of complications.     

腹腔镜辅助或手助结直肠癌根治术

目的总结腹腔镜根治术治疗13例结直肠癌的临床经验。方法回顾分析我科2002年11月-2006年4月13例腹腔镜根治术治疗结直肠癌的临床资料。结肠癌10例，Duke’s A期4例，Duke’s B期6例；直肠癌3例，均为Duke’s A期。结果13例结直肠癌根据肿瘤大小分别采取腹腔镜辅助根治术10例，手助腹腔镜根治术3例，均获成功，无中转开腹手术。无死亡病例。随访1—36个月，平均17个月，未见肿瘤复发。结论依据肿瘤大小和部位选择腹腔镜辅助或手助腹腔镜手术治疗结直肠癌，可以保证手术的安全有效性。     

Risk factor stratification after simultaneous liver and colorectal resection for synchronous colorectal metastasis

Background/aim This study was conducted to devise a prognostic model for patients undergoing simultaneous liver and colorectal resection. Materials and methods A retrospective analysis was performed on 138 colorectal patients who underwent simultaneous liver and colorectal resection between September 1994 and September 2005. The primary endpoint of the study was overall survival. Three patients with positive liver resection margin were excluded from the analysis. Results At multivariate level, poor prognostic factors were liver resection margin ≤5 mm (P = 0.047; relative risk, 1.684; 95% CI = 1.010–2.809), CEA greater than 5 ng/ml (P = <0.001; relative risk, 2.507; 95% CI = 1.499–4.194), number of liver metastasis > 1 (P = <0.042; relative risk, 1.687; 95% CI = 1.020–2.789), and lymph node ≥ 4 (P = <0.012; relative risk, 1.968; 95% CI = 1.158–3.347). The risk stratification grouping of the 135 patients was performed according to the following criteria: low risk group, 0–1 factor; intermediate risk group, 2 factors; high-risk group, 3–4 factors. Of 135 patients, 86 patients (63.0%) were categorized as low-risk group, 36 patients (26.6%) as intermediate risk group, and 14 patients (10.4%) as high-risk group. Median survival times for low, intermediate, high-risk groups were 68.0, 43.6 (95% CI, 24.7–62.4), and 23.5 months (95% CI, 9.4–31.5), respectively. The high-risk group demonstrated an approximately threefold (relative risk, 3.1; 95% CI, 1.6–6.0) increased risk of death. Conclusions A simple risk factor stratification system was proposed to evaluate the chances of cure of patients after simultaneous resection of liver metastases and primary colorectal carcinoma. The risk factor stratification showed three groups with distinct survival. The risk stratification may help to predict patient survival after simultaneous liver and colorectal resection. This system needs further prospective validation.     

对局部晚期结直肠癌患者行联合脏器切除术的临床价值

目的探讨对局部晚期结直肠癌患者行联合受累脏器整块切除的临床价值。方法回顾分析182例局部晚期结直肠癌患者的临床资料。将97例行联合脏器切除治疗患者的疗效与同期85例未行联合脏器切除治疗者进行对比分析。结果97例患者切除的相关脏器为165个,经病理组织学证实51例(52.6%)的50个相关脏器(30.3%)有癌浸润,另外46例(47.4%)的115个(69.7%)相关脏器为炎性浸润,受累脏器以小肠最为常见,占28.9%(28/97)。经联合脏器切除后,97例患者1、3、5年生存率分别为83.5%、67.1%和49.4%;而同期85例仅行肿瘤局部切除或姑息切除治疗者1、3、5年生存率分别为81.1%,58.8%和10.5%。结论对于局部晚期的结直肠癌患者,积极施行周围联合脏器切除术,是提高5年生存率的一项重要措施。     

Therapeutic video-assisted thoracoscopic surgical resection of colorectal pulmonary metastases

Objective: Careful patient selection is vital when video-assisted thoracoscopic surgical (VATS) therapeutic pulmonary metastasectomy of colorectal carcinoma is considered. Complete resection of all metastatic disease remains a vital concept. We reviewed our VATS experience for therapeutic metastasectomy of peripheral colorectal pulmonary metastases. Methods: Over 90 months, therapeutic VATS metastasectomy was accomplished upon 80 patients with colorectal metastases. Thin cut computed tomography (CT) was central in identifying lesions. The mean interval from primary carcinoma to VATS resection was 41 months (1–156 months; median, 33). A solitary lesion was resected in 60 patients and multiple (2–7) lesions resected in 20 patients. Statistics were obtained using the Student's t-test. Results: No operative mortality or major postoperative complications occurred. The hospital stay was 4.5±2.2 days (range, 1–13). All lesions were resected by VATS, with four conversions to thoracotomy to improve the margins. The mean survival of patients with one lesion was 34.8 months compared with 26.5 months for patients with multiple lesions (P=0.37). The mean survival was 20.5 months when metastases occurred <3 years vs. 28.1 months for >3 years from primary carcinoma resection (P=0.20). Twenty-five (31%) patients are disease free; with a mean interval of 38.7 (3–84; median, 35) months. Sixty-nine percent (55/80) of patients developed a recurrence: 6/80 (8%) local; 19/80 (24%) regional (same hemithorax away from resection); and 30/80 (38%) distant. The overall survival at 1 year was 81.2%, 48.4% at 3 years and 30.8% at 5 years. Conclusions: Therapeutic VATS resection of colorectal metastases appears efficacious. Preoperative CT can identify peripheral colorectal metastases amenable to VATS. Conversion to thoracotomy is indicated when none of the lesions identified by CT are found or when clear surgical margins are jeopardized.     

中晚期肝癌的转化手术切除

原发性肝癌是我国常见恶性肿瘤之一,手术治疗是肝癌根治性治疗方式。对于评估为不可切除的部分中晚期肝癌病人,可以通过一些治疗手段将肿瘤转化为可切除,使这些病人得到手术治疗,获得更好的疗效。     

腹腔镜与开放直肠乙状结肠癌切除术术后胰岛素抵抗的差异及其临床意义

目的：比较腹腔镜结直肠切除术（LCR）和传统开放直肠乙状结肠癌切除术（OCR）术后胰岛素抵抗（IR）程度的差异,以及术后患者的早期恢复情况,探讨两种手术方式的临床意义。方法：将60例符合入组条件的结直肠癌患者分为LCR组（30例）和OCR组（30例）,对比两组患者组内与组间、术前术后HOMA指数,以及术后早期恢复指标。结果：两组患者组内比较：术前与术后IR指数均有显著性差异（P〈0.05）,胰岛素分泌指数无显著性差异（P〉0.05）,胰岛素敏感指数均有显著性差异（P〈0.05）;两组患者组间比较：LCR组与OCR组术前IR指数、胰岛素分泌指数、胰岛素敏感指数均无显著性差异（P〉0.05）,术后胰岛素分泌指数无显著性差异（P〉0.05）,IR指数、胰岛素敏感指数有显著性差异（P〈0.05）;两组患者在术后肛门排气时间、术后下床活动时间及术后住院平均天数上有显著性差异（P〈0.01）。结论：LCR较OCR更利于患者的早期恢复。     

结直肠癌同时性肝转移同期与分期手术切除疗效比较

目的：比较结直肠癌同时性肝转移患者原发灶和肝转移灶同期与分期切除的近期和远期结局。方法回顾性分析北京肿瘤医院肝胆胰外一科2003年1月至2011年12月间的64例结直肠癌合并同时性肝转移患者的临床及术后随访资料,其中行原发灶和肝转移灶同期切除者20例（同期切除组）,分期切除者44例（分期切除组）。结果同期切除组Clavien-Dindo 1、2和3级并发症发生率分别为10．0％（2/20）、15．0％（3/20）和15．0％（3/20）,分期切除组分别为13．6％（6/44）、13．6％（6/44）和22．7％（12/44）,差异无统计学意义（P＞0．05）。同期切除组1、2和3年总体生存率分别为85．0％、59．6％和37．2％,分期切除组分别为90．9％、68．2％和47．1％,差异亦无统计学意义（均P＞0．05）。两组中位无病生存时间分别为6月和7月,差异亦无统计学意义（P＞0．05）。多因素预后分析显示,原发灶淋巴结阳性（P=0．020）和肝切除术前CEA水平大于20μg/L（P=0.017）是影响患者总体生存的独立危险因素;复发后有机会接受根治性局部治疗联合化疗则是一项保护性因素（P=0.001）;而手术时机（同期或分期切除）与患者总体生存无关（P＞0．05）。结论对于结直肠癌同时性肝转移,选择同期或分期切除并不影响患者的术后并发症发生率和远期生存率。     

腹腔镜结肠直肠手术的初步经验

目的:探讨腹腔镜结肠直肠手术的手术方法、安全性、并发症及肿瘤复发等问题。方法:经腹腔镜行结肠直肠手术43例,包括右半结肠切除11例,左半结肠切除2例,乙状结肠癌根治术5例,乙状结肠癌姑息性切除术1例,乙状结肠部分切除术2例,Dixon手术15例,Miles手术7例。结果:40例成功地完成手术,3例因肿瘤侵及邻近器官或肥胖而中转开腹手术。平均手术时间为(178.5±50.7)min,结肠癌切除标本上下切缘长度分别为(12.6±2.8cm和10.2±3.4)cm;直肠癌分别为(10.2±2.6)cm和(4.3±2.2)cm,清扫淋巴结数目为(10.4±3.9)枚,其中14例有淋巴结转移。有4例(10%)术后出现并发症。术后13.2±8.1个月,根治性切除的病例平均有2例(6.4%)发生局部复发,1例(3.2%)出现肝转移,无切口和穿刺孔种植转移的发生。结论:腹腔镜结肠直肠手术在技术上是安全可行的,并能达到与开腹手术相同的疗效。     

Analysis of preoperative prognostic factors for long-term survival after hepatic resection of liver metastasis of colorectal carcinoma

Hepatic resection is the most effective therapy for liver metastasis of colorectal carcinoma. To clarify indications for this therapy, the clinicopathologic and follow-up data of 103 consecutive patients who underwent hepatic resection for metastases of colorectal carcinoma were analyzed. Factors influencing overall survival rate were investigated by multivariate analysis. Thereafter, patients who underwent resection were stratified according to the number of independent risk factors present, and their outcomes were compared with those of 14 nonresection patients with fewer than six liver tumors and without extrahepatic metastasis. The overall survival rate of the 103 resection patients was 43.1%. The clinicopathologic factors shown to affect on long-term survival after hepatic resection were the interval between colorectal and hepatic surgery (<12 months), preoperative carcinoembryonic antigen level (>-10 ng/ml), and number of hepatic metastases (four or more). The 5-year overall survival rates were 75.0% with no risk factors (n = 16), 53.6% with one risk factor (n = 46), 23.0% with two risk factors (n = 36), and0%with three risk factors (n = 5). Survival rates did not differ between resection patients with three risk factors and nonresection patients. Therefore, hepatic resection may be appropriate for patients with fewer than three risk factors.     

Long-term survival in patients with ovarian metastases from colorectal carcinoma

Background: Ovarian metastases (OM) are a relatively uncommon consequence of primary colorectal carcinoma (CRC). The authors present a retrospective review of the impact of elective and therapeutic oophorectomy on the natural history of CRC. Methods: Patients with primary CRC from January 1964 through March 1996 were reviewed. Survival from the time of OM diagnosis was estimated by the Kaplan-Meier method; differences between groups were based on the log-rank test. Results: A total of 155 patients were studied. Synchronous OM occurred in 90 patients (58.1%); metachronous OM occurred in 65 patients (41.9%). Estimated 5-year survival for patients with synchronous OM was 9%, versus 20% for metachronous OM (P<.0001). Resection of metastatic disease was associated with an improved 5-year survival for synchronous OM (15% vs. 0%,P=.0001) and metachronous OM (24% vs. 0%,P<.0001) if patients were disease-free postoperatively. Other clinical characteristics, including age, menopausal status, stage, and location of primary tumor, had no significant impact on survival. Conclusions: Ovarian metastases from colorectal carcinoma are associated with a poor outcome. Although there is no survival advantage associated with resection of occult microscopic disease, long-term survival is possible if patients are rendered surgically disease-free.Presented at the 51st Annual Cancer Symposium of The Society of Surgical Oncology, San Diego, California, March 26–29, 1998.