Surgical therapy of advanced (pT4) colon cancer


  • C. Kettelhack
  • A. Friedemann
  • P.M. Schlag


  • Acta Chirurgica Austriaca


  • Acta Chir Austriaca 31 (1): 9-12


  • Background: The therapy of advanced colon cancers (pT4) can be difficult due to infiltration of adjacent structures, as well as due to intraperitoneal tumor cell dissemination. In view of these problems, it is important to consider clear concepts of surgical and interdisciplinary treatment to improve treatment results. Methods: Between August 1994 and August 1997, we surgically treated 23 patients with pT4 colon cancers. The surgical treatment procedures and results are analyzed, in addition to results from the literature. Results: Approximately half of the patients with tumor infiltration of adjacent structures have clinical symptoms indicating this. Blunt separation of tumor adhesions is not appropriate because of a high probability of tumor cell contamination. Resection has to be performed along clinically uninvolved tissue planes, which may often include resection of other organs. Adjuvant chemotherapy is indicated after operation. If there is microscopic residual disease, radiotherapy can reduce the risk of local progression. Conclusions: Advanced colonic carcinomas may often only be resected by extended operation or multivisceral resection if tumor free resection margins are to be achieved. Surgical and medical oncologists should closely collaborate pre-, intra-, and postoperatively. Preoperative radiochemotherapy is a promising attempt if tumor free resection margins do not seem to be primarily achievable.