Multivisceral Resection for Locally Advanced Colon Cancer

Abstract

Introduction: Locally advanced colon cancer invading adjacent organs (T4b) poses a surgical challenge. Multivisceral resection (en bloc removal of the primary tumor with involved organs) is often required. This review examines outcomes of multivisceral resection compared to simple colectomy.

Methods: A systematic review identified studies reporting outcomes of multivisceral resection for T4b colon cancer. Primary outcomes were R0 resection rate, overall survival, and major morbidity. Organ-specific involvement (small bowel, bladder, abdominal wall, duodenum) was analyzed separately.

Results: Twenty studies (over four thousand patients) were included. R0 resection was achieved in seventy to eighty-five percent of multivisceral resections, and these patients had five-year survival of forty to fifty percent. When R0 was not achieved, survival was dismal. Major morbidity was significantly higher than in simple colectomy, particularly with pancreaticoduodenectomy or cystectomy. Mortality ranged from three to eight percent.

Discussion: The survival benefit of multivisceral resection depends entirely on achieving negative margins. Preoperative imaging to assess resectability and need for neoadjuvant therapy is critical. Involvement of the duodenum or pancreas carries the highest morbidity and should be undertaken only at specialized centers. Multidisciplinary planning including urology or vascular surgery is often needed.

Conclusions: Multivisceral resection for locally advanced colon cancer offers acceptable long-term survival when R0 resection is achieved, despite increased morbidity. Patient selection and preoperative optimization are paramount.