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.