Predictors of undergoing multivisceral resection, margin status and survival in Dutch patients with locally advanced colorectal cancer.

BACKGROUND: The aim of this nationwide observational study was to evaluate factors associated with multivisceral resection (MVR), margin status and overall survival in locally advanced colorectal cancer (CRC). MATERIAL AND METHODS: Patients with (y)pT4, cM0 CRC between 2006 and 2017 were selected from the Netherlands Cancer Registry. Cox-proportional hazards modelling was used for survival analysis, stratified for T4a and T4b. Annual hospital volume cut-off was 75 for colon and 40 for rectal resections. RESULTS: A total of 11.930 patients were included and 2410 patients (20.2%) underwent MVR. Factors associated with MVR for colon and rectal cancer besides cT4 category were more recent diagnosis (OR 3.61, CI 95% 3.06-4.25 (colon) and OR 2.72, CI 95% 1.82-4.08 (rectum)) and high hospital volume (OR 1.20, CI 95% 1.05-1.38 (colon) and OR 2.17, CI 95% 1.55-3.04 (rectum)). Patients ≥70 year were less likely to undergo MVR for colon cancer (OR 0.80, 95% CI 0.70-0.90). Risk factors for incomplete resection were cT4 (OR 3.08, CI 95% 2.35-4.04 (colon) and OR 1.82, CI 95% 1.13-2.94 (rectum)) and poor/undifferentiated tumors (OR 1.41, CI 95% 1.14-1.72 (colon) and OR 1.69, CI 95% 1.05-2.74 (rectum)). More recent diagnosis was independently associated with less incomplete resections in colon cancer (OR 0.58, CI 95% 0.40-0.76). Independent predictors of survival were age, resection margin, nodal status and adjuvant chemotherapy, but not MVR. CONCLUSION: Treatment of locally advanced CRC with MVR at population level was influenced by year of diagnosis and hospital volume. Margin status in colon cancer improved substantially over time.

[Carcinoma of the colon with bladder invasion; what is the role of preoperative chemotherapy?] / Coloncarcinoom met doorgroei in de blaas.

Preoperative chemotherapy followed by surgery was applied in three patients, aged 68 years (male), 48 years (female), and 80 years (male) with locally advanced cancer of the colon with bladder invasion. Achieving a resection with free margins (R0) is essential in colon-cancer surgery, but the role of preoperative chemotherapy in colon cancer remains unknown. When a tumour is presumed to be unresectable, guidelines recommend discussing the case and possibly referring the patient to an oncological expertise centre, where each patient will be individually assessed for the most suitable preoperative treatment and surgery during a multidisciplinary tumour board meeting. All three patients showed that preoperative chemotherapy led to down-staging and reduction of the tumour size, although removal of the bladder was still necessary in one patient. All patients underwent a complete resection, which resulted in long-term disease-free and overall survival.