Annals of Surgical Oncology Cite Track
HOME HELP FEEDBACK SUBSCRIPTIONS ARCHIVE SEARCH TABLE OF CONTENTS
10.1245/s10434-008-9930-1
Annals of Surgical Oncology 15:1923-1930 (2008)
© 2008 Society of Surgical Oncology
This Article
Right arrow Full Text
Right arrow Full Text (PDF)
Right arrow Alert me when this article is cited
Right arrow Alert me if a correction is posted
Services
Right arrow Similar articles in this journal
Right arrow Similar articles in PubMed
Right arrow Alert me to new issues of the journal
Right arrow Download to citation manager
Google Scholar
Right arrow Articles by Govindarajan, A.
Right arrow Articles by Gagliardi, A. R.
PubMed
Right arrow PubMed Citation
Right arrow Articles by Govindarajan, A.
Right arrow Articles by Gagliardi, A. R.

Original Article

Predictors of Multivisceral Resection in Patients with Locally Advanced Colorectal Cancer

Anand Govindarajan, MD, MSc1, Novlette Fraser, MA1, Vanessa Cranford, MD2, Debrah Wirtzfeld, MD2, Steve Gallinger, MD3, Calvin H. L. Law, MD, MPH1, Andrew J. Smith, MD, MSc1 and Anna R. Gagliardi, PhD1

1 Sunnybrook Health Sciences Centre, Toronto, ON, Canada M4N3M5
2 Memorial University Health Sciences Centre, St. John’s, Newfoundland and Labrador, Canada
3 Mount Sinai Hospital, Toronto, ON, Canada

Correspondence: Address correspondence and reprint requests to: Anna R. Gagliardi, PhD; E-mail: anna.gagliardi{at}sunnybrook.ca

Background: Practice guidelines recommend en bloc multivisceral resection (MVR) for all involved organs in patients with locally advanced adherent colorectal cancer (LAACRC) to reduce local recurrence and improve survival. We found that MVR was performed in one-third of eligible American patients in the Surveillance, Epidemiology and End Results cancer registry but that study could not identify factors amenable to quality improvement. This study was conducted to examine rates, and predictors of MVR among Canadian patients with LAACRC.

Methods: Rates of MVR were examined by observational study. Eligible patients were aged 20–74 years who had surgery for nonmetastatic LAACRC from July 1997 to December 2000. Patient, tumor, surgeon, and hospital characteristics were extracted from medical records. Summary statistics were compared by type of surgery (MVR, partial MVR, standard resection). To identify factors associated with MVR we analyzed operative notes and transcripts from interviews with general surgeons using standard qualitative methods.

Results: Factors associated with MVR included fewer years in practice, preoperative treatment planning, involvement of surgical consultants, and access to diagnostic imaging and systems to enable preoperative multidisciplinary planning. Judgments regarding the nature of peritumoral adhesions, resectability, and personal technical skill may mediate decision-making. Many surgeons would prefer to refer patients than undertake complicated, lengthy cases.

Conclusion: Further research is required to validate these findings in larger studies and among patients undergoing surgery for conditions other than LAACRC, and evaluate strategies to improve rates of MVR through enhanced individual awareness and system capacity.

Key Words: Colorectal neoplasms • Multivisceral resection • Decision-making • Practice guideline adherence • Continuing education • Quality improvement






HOME HELP FEEDBACK SUBSCRIPTIONS ARCHIVE SEARCH TABLE OF CONTENTS
Copyright © 2008 by the Society of Surgical Oncology.