Multivisceral Resection Serves as a Key Indicator of Recurrence in Locally Advanced Colorectal Cancers with Pathological T3 Tumors.

Abstract

Purpose: This study aimed to elucidate the clinical outcomes of patients with pathological T3 and T4 tumors undergoing radical resection with multivisceral resection (MVR), and to assess the prognostic significance of MVR in locally advanced colorectal cancers (CRC) in pT3-4 tumors.

Methods: This multicenter retrospective analysis evaluated the characteristics, clinicopathological stages, perioperative factors, and clinical outcomes of patients who underwent primary colorectal resection. Patients were divided into four groups: those with a pT3 tumor who did not undergo MVR (pT3-MVR; n=1108), those with a pT3 tumor who did undergo MVR (pT3+MVR; n=56), those with a pT4 tumor who did not undergo MVR (pT4-MVR; n=306), and those with a pT4 tumor who did undergo MVR (pT4+MVR; n=123). Univariate and multivariate regression analyses were performed to identify risk factors for recurrence.

Results: The pT3+MVR group exhibited a higher 5-year recurrence rate than the pT3-MVR group, with recurrence rates similar to those of the pT4-MVR or pT4+MVR groups (pT3-MVR, 17.4%; pT3+MVR, 31.6%; pT4-MVR, 33.4%; and pT4+MVR, 35.1%). Multivariate analysis identified MVR as an independent risk factor for recurrence, particularly peritoneal dissemination, in pT3 tumors, whereas MVR had less impact on recurrence in pT4 tumors.

Conclusion: pT3 tumors requiring MVR had a high recurrence rate comparable to that of pT4 tumors. The surgeon's clinical assessment of a potential T4 tumors requiring MVR at the time of surgery was an important prognostic indicator in advanced CRC.