LONG-TERM SURVIVAL AFTER RESECTION OF LOCALLY ADVANCED COLORECTAL CARCINOMAS (T4)

Between 1972 and 1990, 456 patients with locally advanced colorectal carcinomas (tumor stage T4) were operated. In 187 cases the operation was extended by multivisceral resection and in 269 patients a conventional resection was performed. The rate of curative R0-resections was 74,9 % for the extended resection group compared to 66,2 % for the conventional group. The postoperative mortality after extended resection was 4,9 % (2,9 % conventional resection). Analyses of long-term results showed a 5-year survival for all R0-resected cases of 52,1 % +/- 4,1. Further evaluation of additional lymph-node involvement in T4 colorectal tumors revealed significant differences in 5-year survival: 64,8 % T4N0; 27,9 % T4N1,2; 9,2 % T4N3 for conventional R0-resection and 59,9 % T4N0; 23,2 % T4N1,2; 6,6 % T4N3 for extended R0-resection. After curative resection (R0) the presence or absence of intraoperative tumor-cell dissemination could be identified as a significant prognostic factor. In all cases of T4 colorectal carcinomas - especially for N1-3 - an adjuvant treatment after conventional or extended R0-resection is recommended.