Discussion
En bloc resection is sometimes required to cure T4B stage colorectal
cancer[5]. Many investigators have
reported that this resection for colorectal cancer has acceptable
morbidity and mortality rates and a fair long-term prognosis; therefore,
they have emphasized the benefits of this
procedure[4]. However, a highly
extended operation like an en bloc resections is also recognized to
increase morbidity and mortality. Some large tumors that have invaded
neighboring organs, such as the pelvic organs and pancreas, are
unresectable because of the dangers posed by high surgical
stress[6].
To date, several studies have reported the En bloc resection for T4B
colorectal cancer that has invaded adjacent organs, such as the urinary
bladder[7], anal
sphincter[8], and
liver[9]. However, very few studies
have reported the MVR for T4B colorectal cancer that has invaded the
right hepatic lobe, gastric antrum, and duodenum. Our study showed that
performing a right hemicolectomy and pancreaticoduodenectomy was safe
for these patients.
The combination of the analyzed factors associated with the MVR or other
factors related to the MVR, such as the number of anastomoses and width
of dissection, could be speculated to affect the occurrence of
complications. Reducing the mortality and morbidity rate is challenging.
Some studies have showed that en bloc resections increased the rates of
infectious complications and ileus, but not other noninfectious
complications[10]. Other studies have
showed that tumor size and depth of invasion, both of which were
associated with en-bloc resection, are independent risk factors,
although in combination they might influence
morbidity[11]. In our study, we found
no postoperative morbidity, anastomotic leakage, or postoperative
infection.
For T4B colorectal cancer, we emphasize that en-bloc resection of the
tumor and the adjacent infiltrated organs is advisable in suitable
patients, in order to avoid jeopardizing complete tumor excision in a
patient who has a realistic chance of cure.
In conclusion, to achieve better oncologic outcome, en bloc colorectal
cancer resection should be performed. Admittedly, some patients may be
over treated by this aggressive approach; however, when practiced by
experienced surgeons, en bloc resection usually carries no added
morbidity and guarantees a better oncologic outcome.