Abstract
BACKGROUND: Locally advanced, recurrent colorectal cancer involving the aortoiliac axis may be considered a contraindication for curative surgery because of the technical challenges of achieving a negative margin resection and an assumed poor prognosis. OBJECTIVE: The aim of this study was to assess oncologic outcomes and the ability to achieve an R0 resection in these patients. DESIGN: A retrospective review of a prospectively maintained colorectal cancer database identified 406 consecutive patients who underwent surgery for locally recurrent colorectal cancer between 1997 and 2007. SETTING: This study was conducted at an academic multidisciplinary tertiary center. PATIENTS: The demographic and clinicopathological features of patients undergoing resection for locally advanced disease involving the aortoiliac axis at our institution were reviewed. RESULTS: Twelve patients (7 women, median age 51 years) were identified. Major vessel involvement included internal iliac artery (n = 7), common iliac artery (n = 5), external iliac artery (n = 3), aorta (n = 3), internal iliac vein (n = 2), and external iliac vein (n = 1). R0 resection was achieved in 7 patients, and R1 resection in 5. Eleven patients received intraoperative radiation therapy. Vascular reconstruction (3 aorta, 5 common iliac, 3 external iliac) included synthetic interposition grafts, femoral-femoral bypasses, or primary anastomosis. One patient underwent venous reconstruction of the external iliac vein. No graft complications were encountered, and graft patency at 4 years was 100%. Thirty-day morbidity was seen in 9 patients, 8 of whom had Clavien grade <3. Thirty-day mortality was nil. Overall and disease-free survival at 4 years was 55% and 45%. LIMITATIONS: This study was limited by its sample size, retrospective design, and the number of outcome events. CONCLUSION: R0 resection of locally advanced recurrent colorectal cancer involving the aortoiliac axis was achieved in over 50% of patients. Overall and disease-free survival was comparable to outcomes seen with locally advanced disease to nonvascular structures.
| Original language | English (US) |
|---|---|
| Pages (from-to) | 711-716 |
| Number of pages | 6 |
| Journal | Diseases of the Colon and Rectum |
| Volume | 56 |
| Issue number | 6 |
| DOIs | |
| State | Published - Jun 2013 |
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Keywords
- Recurrent colorectal cancer
- Survival
- Vascular involvement
- Vascular reconstruction
ASJC Scopus subject areas
- Gastroenterology
Cite this
Surgery for locally advanced recurrent colorectal cancer involving the aortoiliac axis : Can we achieve r0 resection and long-term survival? / Abdelsattar, Zaid M.; Mathis, Kellie L.; Colibaseanu, Dorin T.; Merchea, Amit; Bower, Thomas C.; Larson, David; Dozois, Eric.
In: Diseases of the Colon and Rectum, Vol. 56, No. 6, 06.2013, p. 711-716.Research output: Contribution to journal › Review article
}
TY - JOUR
T1 - Surgery for locally advanced recurrent colorectal cancer involving the aortoiliac axis
T2 - Can we achieve r0 resection and long-term survival?
AU - Abdelsattar, Zaid M.
AU - Mathis, Kellie L.
AU - Colibaseanu, Dorin T.
AU - Merchea, Amit
AU - Bower, Thomas C.
AU - Larson, David
AU - Dozois, Eric
PY - 2013/6
Y1 - 2013/6
N2 - BACKGROUND: Locally advanced, recurrent colorectal cancer involving the aortoiliac axis may be considered a contraindication for curative surgery because of the technical challenges of achieving a negative margin resection and an assumed poor prognosis. OBJECTIVE: The aim of this study was to assess oncologic outcomes and the ability to achieve an R0 resection in these patients. DESIGN: A retrospective review of a prospectively maintained colorectal cancer database identified 406 consecutive patients who underwent surgery for locally recurrent colorectal cancer between 1997 and 2007. SETTING: This study was conducted at an academic multidisciplinary tertiary center. PATIENTS: The demographic and clinicopathological features of patients undergoing resection for locally advanced disease involving the aortoiliac axis at our institution were reviewed. RESULTS: Twelve patients (7 women, median age 51 years) were identified. Major vessel involvement included internal iliac artery (n = 7), common iliac artery (n = 5), external iliac artery (n = 3), aorta (n = 3), internal iliac vein (n = 2), and external iliac vein (n = 1). R0 resection was achieved in 7 patients, and R1 resection in 5. Eleven patients received intraoperative radiation therapy. Vascular reconstruction (3 aorta, 5 common iliac, 3 external iliac) included synthetic interposition grafts, femoral-femoral bypasses, or primary anastomosis. One patient underwent venous reconstruction of the external iliac vein. No graft complications were encountered, and graft patency at 4 years was 100%. Thirty-day morbidity was seen in 9 patients, 8 of whom had Clavien grade <3. Thirty-day mortality was nil. Overall and disease-free survival at 4 years was 55% and 45%. LIMITATIONS: This study was limited by its sample size, retrospective design, and the number of outcome events. CONCLUSION: R0 resection of locally advanced recurrent colorectal cancer involving the aortoiliac axis was achieved in over 50% of patients. Overall and disease-free survival was comparable to outcomes seen with locally advanced disease to nonvascular structures.
AB - BACKGROUND: Locally advanced, recurrent colorectal cancer involving the aortoiliac axis may be considered a contraindication for curative surgery because of the technical challenges of achieving a negative margin resection and an assumed poor prognosis. OBJECTIVE: The aim of this study was to assess oncologic outcomes and the ability to achieve an R0 resection in these patients. DESIGN: A retrospective review of a prospectively maintained colorectal cancer database identified 406 consecutive patients who underwent surgery for locally recurrent colorectal cancer between 1997 and 2007. SETTING: This study was conducted at an academic multidisciplinary tertiary center. PATIENTS: The demographic and clinicopathological features of patients undergoing resection for locally advanced disease involving the aortoiliac axis at our institution were reviewed. RESULTS: Twelve patients (7 women, median age 51 years) were identified. Major vessel involvement included internal iliac artery (n = 7), common iliac artery (n = 5), external iliac artery (n = 3), aorta (n = 3), internal iliac vein (n = 2), and external iliac vein (n = 1). R0 resection was achieved in 7 patients, and R1 resection in 5. Eleven patients received intraoperative radiation therapy. Vascular reconstruction (3 aorta, 5 common iliac, 3 external iliac) included synthetic interposition grafts, femoral-femoral bypasses, or primary anastomosis. One patient underwent venous reconstruction of the external iliac vein. No graft complications were encountered, and graft patency at 4 years was 100%. Thirty-day morbidity was seen in 9 patients, 8 of whom had Clavien grade <3. Thirty-day mortality was nil. Overall and disease-free survival at 4 years was 55% and 45%. LIMITATIONS: This study was limited by its sample size, retrospective design, and the number of outcome events. CONCLUSION: R0 resection of locally advanced recurrent colorectal cancer involving the aortoiliac axis was achieved in over 50% of patients. Overall and disease-free survival was comparable to outcomes seen with locally advanced disease to nonvascular structures.
KW - Recurrent colorectal cancer
KW - Survival
KW - Vascular involvement
KW - Vascular reconstruction
UR - http://www.scopus.com/inward/record.url?scp=84879089126&partnerID=8YFLogxK
UR - http://www.scopus.com/inward/citedby.url?scp=84879089126&partnerID=8YFLogxK
U2 - 10.1097/DCR.0b013e31827dbcb0
DO - 10.1097/DCR.0b013e31827dbcb0
M3 - Review article
C2 - 23652744
AN - SCOPUS:84879089126
VL - 56
SP - 711
EP - 716
JO - Diseases of the Colon and Rectum
JF - Diseases of the Colon and Rectum
SN - 0012-3706
IS - 6
ER -