Multivisceral resections as a treatment option for locally advanced colon cancer with hepatopancreatobiliary involvement

Schepotin I.B., Kolesnik E.A., Lukashenko A., Mahmudov D.E.

Summary. En-bloc multivisceral resection (MVR) is a commonly considered golden standard treatment option for locally advancer colonic cancer. Invasion into hepatopancreatobiliary zone (HPBZ) organs remains to be an underevaluated form of this morbidity, leavilg plenty of surgical strategy questions unsolved. The aim of this study was to assess short- and long-term outcomes of locally advanced colonic cancer with HPBZ structures involvement treatment. A total of 625 patients were studied. Among them MVR were performed in 237 cases (34%), 39 (16,5%) — because of HPBZ structures involvement. Additionally an analyze of 32 locally advanced colonic cancer with HPBZ structures invasion patients, who underwent standard palliative (R1 or R2) colonic resections. Class III–IV Clavien—Dindo complications and postoperative mortality in groups of all MVR, MVR with HPBZ structures invasion and in a group of patients with palliative resections appeared to be 19 and 3,3%, 39 and 0%, 6,25 and 3% respectively. The main types of complications were septic and purulent ones, among patients after MVR with HPBZ structures invasion — external pancreatic fistula. Overall 5-year survival in a group of all MVR patients was 60,7±3,9%, median survival — 23 months, in a group of MVR with HPBZ structures invasion — 49±3%, median survival — 19,6 months. In a subgroup of patients, who underwent palliative colonic resections (R1-2), — 6±4% with median survival — 4,2 months. Performing of MVR in patients with locally advanced colonic cancer with HPBZ structures invasion should be considered as justified and favorable treatment options. However, the rate of overall surgical complications appears to be significantly higher, this treatment option has the capability to strongly improve long-term treatment outcomes.
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