Is it Possible to Successfully Treat Locally Advanced Colon Cancer Using Pre-Operative Chemoradiotherapy?

Pre-operative chemoradiotherapy (CRT) is a preferable treatment option for patients with locally advanced rectal cancer. However, few data are available regarding pre-operative CRT for locally advanced colon cancer. Here, we describe two cases of successful treatment with pre-operative CRT and establish evidence supporting this treatment option in patients with locally advanced colon cancer. In the first case, a 65-year-old woman was diagnosed with ascending colon cancer with duodenal invasion. In the second case, a 63-year-old man was diagnosed with a colonic-duodenal fistula due to transverse colon cancer invasion. These case reports will help to establish a treatment consensus for pre-operative CRT in patients with locally advanced colon cancer.

Concomitant Adjacent Organ Resection in Locally Advanced Colon Cancer

PURPOSE: In locally advanced adherent colon cancer surgery, a mutivisceral resection is known to reduce local recurrence and improve survival. Practically, the benefit of using this procedure may outweigh the risk of associated morbidity, but the procedure may not be performed uniformly. We reviewed the results of multivisceral resections for locally advanced colon cancer. METHODS: From 2003 January to 2008 January, 476 colon cancer patients underwent surgery for locally advanced colon cancer in our hospital. Out of the 476 patients, 36 patients with pT3-pT4 who underwent any kind of adjacent organ resection other than a resection of the colon were reviewed retrospectively. RESULTS: Out of the 36 patients, 22 were male and 14 were female, and the mean age was 63.44+/-13.26 yr. The sigmoid colon was the most common location for the primary lesion, followed by the ascending colon, the transverse colon, and the cecum. Invaded organs were the abdominal or pelvic wall in 5 patients, the visceral organs in 26 patients, the retroperitoneum in 2 patients. All patients received an en-bloc resection of the invaded organs. Ten patients were stage II, 14 patients were stage III, and 12 patients were stage IV. Fifteen patients were disease free at the end of this study, local recurrence had occurred in 1 patient, 6 patients had an intraabdominal recurrence, and 2 patients had developed a distant metastasis. The overall complication rate was 28%. The 5-yr survival rate of each stage according to the surgical approach did not show any meaningful difference. CONCLUSION: A multivisceral en-bloc resection has been recommended for locally advanced adherent colon cancer patients. To improve the outcome, we suggest progressive surgical treatment in such patients.

Intraoperative intraperitoneal chemotherapy with sustained-release 5-fluorouracil for treatment of locally advanced colon cancer / 上海第二医科大学学报

Objective To evaluate the effects of intraoperative intraperitoneal chemotherapy with sustained release 5-fluorouracil for implantation(5-Fu SRI) for the treatment of locally advanced colon cancer. Methods A total of 70 patients with locally advanced primary colon cancer(T4N0M0 and stage Ⅲ) undergoing radical resection were divided into treatment group(n=36,intraoperative intraperitoneal chemotherapy with 600mg 5-Fu SRI)and control group(n=34,intraoperative intraperitoneal flushing with 1000mg 5-fluorouracil injection). Both groups received the same postoperative chemotherapy regime.The 2-year survival rate,local recurrence rate and distant metastasis rate were retrospectively analysed. Results The 2-year survival rate and local recurrence rate were more favourable in treatment group than those in control group(P0.05). Conclusion Intraoperative intraperitoneal chemotherapy with 5-Fu SRI may decrease postoperative local recurrence rate and increase 2year survival rate.