Should we Operate on the Locally Advanced Colorectal Cancer at any Cost but When Should not Give Up Though ?

Introduction: When T4 tumors infiltrated only the intestinal wall, survival and locoregional recurrence rates were similar in the case of T4a, while T4b tumors, with the participation of adjacent structures are associated with increased incidence of recurrence and decreased survival. Locally Advanced Colorectal Cancer (LACRC) may vary from visible intimately adhered to the surrounding tissue, i.e. marginal, “border” resectable tumor to one that directly macroscopic engages adjacent critical structures. The terms “unresectable”, “inoperable” and “incurable” cancer / patient are widely used but not clearly defined, item of significant subjectivity. Where is the limit of “resectability” of locally advanced colorectal cancer? This report presents the experience of other foreign authors with their results in the determination of the tumor as resectable or unresectable and our own clinic experience in this area. Materials and Methods: A retrospective, critical and comparative analysis of patients operated in our clinic with locally advanced primary and recurrent colorectal cancer in period of 10 years with the requirements for individualized “Team” approach of preoperative and intraoperative staging, planning and execution of multivisceral “en-block” resection with typical technical difficulties, complications and results. Results: From 1105 surgeries on the occasion of colorectal cancer as advanced disease constitute 29.6 percent 327 patients. 54.5% are localized in different parts of the colon and the others – 45.5% in the rectum. Age between 61 and 80 years is the most affected. Males are 57.73% and females – 42.27%. There were performed 108 combined multivisceral resections – in 79 primary and 29 recurrent tumors as 17 of them (8 recurrent tumors) are established pathologicaly as pR1, i.e. non radical result. 219 cases were assessed intraoperatively as non radical surgery suited and palliative procedures were performed resections (with or without restoration of the intestinal passage, but in the case of M1), bypass anastomoses or simple interruption of the passage, including cryo-destruction. The overall survival rate is 34 months for pR0-resected and 12 months for pR1-cases (p<0.05). Discussion: Many of the world’s leading surgical centers adopt the tactics of “adequate aggressive behavior” for locally advanced primary and recurrent colorectal cancer. In determining a reasonable balance between aggressive approach and so called meaningless “surgical exorbitance” we strive to adhere to the view that failure to achieve R0-resection planed in such operation, as well as leading worse performance status of the patient or a combination of factors such as advanced age, severe co-morbidities, the presence of complicated forms of colorectal cancer, urgent intervention and data of generalization of the malignant process undermines the implementation of aggressively block removal of the tumor formation. However, adequate preand intraoperative assessment and surgical experience should avoid “exaggerated” on intraoperative status of locally advanced tumor and passively determination as “unresectable. ” It is justified the opinion that the adequate, in particular disease, reasonably aggressive pattern to LACRC securing the most favorable long-term survival prognosis.