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Subclassification of Multivisceral Resections for T4b Colon Cancer with Relevance for Postoperative Complications and Oncological Risks
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....
Autores principales: | , , , , , , , , , |
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Formato: | Online Artículo Texto |
Lenguaje: | English |
Publicado: |
Springer US
2019
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Materias: | |
Acceso en línea: | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7441085/ https://www.ncbi.nlm.nih.gov/pubmed/31749095 http://dx.doi.org/10.1007/s11605-019-04426-3 |
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author | Wasmann, Karin A. T. G. M. Klaver, Charlotte E. L. van der Bilt, Jarmila D. W. Nagtegaal, Iris D. Wolthuis, Albert M. van Santvoort, Hjalmar C. Ramshorst, Bert D’Hoore, André de Wilt, Johannes H. W. Tanis, Pieter J. |
author_facet | Wasmann, Karin A. T. G. M. Klaver, Charlotte E. L. van der Bilt, Jarmila D. W. Nagtegaal, Iris D. Wolthuis, Albert M. van Santvoort, Hjalmar C. Ramshorst, Bert D’Hoore, André de Wilt, Johannes H. W. Tanis, Pieter J. |
author_sort | Wasmann, Karin A. T. G. M. |
collection | PubMed |
description | 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). ELECTRONIC SUPPLEMENTARY MATERIAL: The online version of this article (10.1007/s11605-019-04426-3) contains supplementary material, which is available to authorized users. |
format | Online Article Text |
id | pubmed-7441085 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2019 |
publisher | Springer US |
record_format | MEDLINE/PubMed |
spelling | pubmed-74410852020-08-27 Subclassification of Multivisceral Resections for T4b Colon Cancer with Relevance for Postoperative Complications and Oncological Risks Wasmann, Karin A. T. G. M. Klaver, Charlotte E. L. van der Bilt, Jarmila D. W. Nagtegaal, Iris D. Wolthuis, Albert M. van Santvoort, Hjalmar C. Ramshorst, Bert D’Hoore, André de Wilt, Johannes H. W. Tanis, Pieter J. J Gastrointest Surg Original Article 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). ELECTRONIC SUPPLEMENTARY MATERIAL: The online version of this article (10.1007/s11605-019-04426-3) contains supplementary material, which is available to authorized users. Springer US 2019-11-20 2020 /pmc/articles/PMC7441085/ /pubmed/31749095 http://dx.doi.org/10.1007/s11605-019-04426-3 Text en © The Author(s) 2019 https://creativecommons.org/licenses/by/4.0/Open Access This article is distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/ (https://creativecommons.org/licenses/by/4.0/) ), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. |
spellingShingle | Original Article Wasmann, Karin A. T. G. M. Klaver, Charlotte E. L. van der Bilt, Jarmila D. W. Nagtegaal, Iris D. Wolthuis, Albert M. van Santvoort, Hjalmar C. Ramshorst, Bert D’Hoore, André de Wilt, Johannes H. W. Tanis, Pieter J. Subclassification of Multivisceral Resections for T4b Colon Cancer with Relevance for Postoperative Complications and Oncological Risks |
title | Subclassification of Multivisceral Resections for T4b Colon Cancer with Relevance for Postoperative Complications and Oncological Risks |
title_full | Subclassification of Multivisceral Resections for T4b Colon Cancer with Relevance for Postoperative Complications and Oncological Risks |
title_fullStr | Subclassification of Multivisceral Resections for T4b Colon Cancer with Relevance for Postoperative Complications and Oncological Risks |
title_full_unstemmed | Subclassification of Multivisceral Resections for T4b Colon Cancer with Relevance for Postoperative Complications and Oncological Risks |
title_short | Subclassification of Multivisceral Resections for T4b Colon Cancer with Relevance for Postoperative Complications and Oncological Risks |
title_sort | subclassification of multivisceral resections for t4b colon cancer with relevance for postoperative complications and oncological risks |
topic | Original Article |
url | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7441085/ https://www.ncbi.nlm.nih.gov/pubmed/31749095 http://dx.doi.org/10.1007/s11605-019-04426-3 |
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