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Cherukula A, Agrawal S, Jajoo SN, Saxena G. Radical Resection for Locally Advanced Colon Cancer With Bladder Involvement Treated in a Tertiary Health Care Centre. Cureus 2024; 16:e54333. [PMID: 38500924 PMCID: PMC10945465 DOI: 10.7759/cureus.54333] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2023] [Accepted: 02/16/2024] [Indexed: 03/20/2024] Open
Abstract
Colorectal cancer with involvement of the urinary bladder is infrequent in the nonmetastatic setting. Procedures for advanced colorectal cancers with bladder involvement may include partial or complete bladder resections. Proper therapeutic management principles dictate radical surgery when negative margins can be obtained. High-resolution CT imaging along with endoscopic evaluation of the urinary bladder is frequently required to assess the extent of urinary bladder dissection. Here, we present a case of adenocarcinoma of the sigmoid colon with urinary bladder involvement and its treatment.
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Affiliation(s)
- Anilreddy Cherukula
- Department of General Surgery, Datta Meghe Institute of Medical Sciences, Wardha, IND
| | - Suraj Agrawal
- Department of Surgery, Jawaharlal Nehru Medical College, Acharya Vinoba Bhave Rural Hospital, Wardha, IND
| | - Suhas N Jajoo
- Department of General Surgery, Jawaharlal Nehru Medical College, Datta Meghe Institute of Medical Sciences, Wardha, IND
| | - Garima Saxena
- Department of General Surgery, Jawaharlal Nehru Medical College, Datta Meghe Institute of Medical Sciences, Wardha, IND
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Multivisceral Resection of Advanced Sigmoid Colon Cancer. ARS MEDICA TOMITANA 2021. [DOI: 10.2478/arsm-2020-0019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Abstract
Introduction: Colorectal cancer is one of the most common digestive malignancies, with a high mortality and morbidity rate, with nonspecific symptoms in the early stages and with a diagnosis in the advanced stage most often. In a significant percentage there are cases in which tumors with invasion in the border organs and multiorgan resections are required. In women, the invasion frequently occurs in the vagina, uterus and bladder.
Case report: We report the case of a 52-year-old woman, who presented in the Department of Surgery with the following complaints: fecaluria, pneumaturia, constipation and moderate abdominal pain, with onset of 4 months, in wich the patient neglected her symptoms. Following the investigations, a large tumor formation of sigmoid colon was diagnosed, with invasion in the uterus and bladder, with which it communicates through a 16mm fistula. The result of the biopsy was of low / moderate grade adenocarcinoma differentiated G2. Cystoscopy revealed bladder trigone invasion without being able to identify ureteral orifices, biopsy and urine cytology was also positive for cancer. The surgery was performed by a multidisciplinary team and a multivisceral resection was performed.
Conclusions: Multiorgan resections require trained, experienced teams, and oncological pathology raises special issues when it comes to radical visa. The management of invasive colonic tumors in the border organs must be established preoperatively, in agreement with the patient, because it involves problems related to the quality of life and the potential for survival.
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Vuillermet C, Meillat H, Manceau G, Creavin B, Eveno C, Benoist S, Parc Y, Lefevre JH. Advanced colonic cancer with clinically suspected bladder invasion: Outcomes and prognosis from a multicentric study of 117 patients from the FRENCH research group. Surgery 2020; 168:786-792. [PMID: 32771298 DOI: 10.1016/j.surg.2020.06.021] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2020] [Revised: 05/26/2020] [Accepted: 06/03/2020] [Indexed: 11/24/2022]
Abstract
BACKGROUND Bladder invasion by colon cancer is rare; however, its management is still controversial. Our objective was to report outcomes and identify risk factors for local recurrence in colon cancer with clinically suspected bladder invasion. METHODS We conducted a retrospective study in 23 centers in France. All patients who underwent colon surgery with bladder resection (2010-2017) were included. Metastatic and recurrent colon cancers were excluded. RESULTS One hundred and seventeen patients (men = 73) were included. Partial cystectomy occurred in 108 patients (92.3%), with a total cystectomy occurring in 9 patients (7.7%). Neoadjuvant treatment was given to 31 patients (26.5%). Major morbidity was 20.5%. R0 resection rates were 87.2%. Histologically confirmed bladder invasion was present in 47%. Thirty-four patients were pN+, while 60 patients (51.3%) received adjuvant chemotherapy. Mean follow-up was 33.8 months. Three-year overall survival and disease-free survival were 82.9% and 59.5%. Rates of local recurrence and distant recurrence were 14.5% and 18.8%, respectively; the local recurrences (11/17; 65%) were in the bladder, while 4 of these patients had a bladder recurrence despite not having histologically confirmed bladder invasion at the index surgery. The rate of bladder recurrence after histologic bladder invasion was 13% (7/55), while the rate of bladder recurrence without primary bladder invasion was 7% (4/62) (P = .343). Neoadjuvant therapy, type of cystectomy, and adjuvant therapy did not influence local recurrence (P > .445 each). R1 bladder resections, when compared with a R0 bladder resections, were associated with an increased rate of local recurrence (63% vs 10%; P < .0001). CONCLUSION Clinically suspected bladder invasion increases local recurrence even in the absence of histologically confirmed bladder invasion. Only complete resections with R0 margins decrease local recurrence. Careful, detailed postoperative surveillance is required, even without pathologic bladder invasion.
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Affiliation(s)
- Cindy Vuillermet
- Sorbonne Université, Department of Digestive Surgery, AP-HP, Hôpital Saint Antoine, Paris, France
| | - Hélène Meillat
- Department of Surgical Oncology, Institut Paoli-Calmettes, Marseille, France
| | - Gilles Manceau
- Department of Digestive Surgery, Pitié Salpêtrière Hospital, AP-HP, Sorbonne University, Paris, France
| | - Ben Creavin
- Department of Surgery, St Vincent's University Hospital, Elm Park, Dublin, Ireland
| | - Clarisse Eveno
- Department of Digestive and Oncological Surgery, University Hospital C. Huriez, Lille, France
| | - Stéphane Benoist
- Department of Digestive Surgery, Bicêtre Hospital, University Paris Sud XI, 7, Le Kremlin-Bicêtre, France
| | - Yann Parc
- Sorbonne Université, Department of Digestive Surgery, AP-HP, Hôpital Saint Antoine, Paris, France
| | - Jérémie H Lefevre
- Sorbonne Université, Department of Digestive Surgery, AP-HP, Hôpital Saint Antoine, Paris, France.
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Nerli RB, Ghagane SC, Ram P, Shimikore SS, Vinchurkar K, Hiremath MB. Bladder Invasion in Patients with Advanced Colorectal Carcinoma. Indian J Surg Oncol 2018; 9:547-551. [PMID: 30538386 DOI: 10.1007/s13193-018-0788-9] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2017] [Accepted: 07/13/2018] [Indexed: 11/24/2022] Open
Abstract
Involvement of the bladder by colorectal cancer is sufficiently rare to be encountered by an individual surgeon on an infrequent basis. Extirpative procedures for advanced colorectal cancers can involve partial/total bladder resections. In patients without evidence of distant metastatic disease, a reasonable therapeutic effect can be expected when negative surgical margins are obtained. The decision to perform a bladder-sparing procedure or a total pelvic exenteration (TPE) will be based on the extent of the primary lesion as well as patient characteristics. In this study, we report our experience in the management of operable locally advanced colorectal carcinomas involving the urinary bladder. We retrospectively reviewed the hospital records of all patients with advanced colorectal cancer invading the urinary bladder. The age, gender, clinical presentation, physical examination findings, and imaging records were noted. Colonoscopy reports and images were noted and biopsy findings recorded. Similarly, cystoscopy findings and biopsy reports were noted and analyzed. Eight (88%) patients had a primary sigmoid tumor and one (11%) had primary rectal tumor. The clinical staging of the primary tumor was T3 in three (33%) and T4 in six (66%). A biopsy taken during cystoscopy confirmed the malignant lesion in all the nine patients. Four (44%) patients received neoadjuvant chemotherapy with 5-fluorouracil. Eight (88%) patients underwent bladder-sparing resection and the remaining one underwent total pelvic exenteration with ileal conduit for urinary drainage. The mean overall survival was 44 months. The wide spectrum of possible bladder involvement by colorectal cancer requires individual patient-specific and disease-specific approaches. En bloc bladder resection for adherent or invading colorectal cancers achieves good local control and prognosis. The potential for cure in completely excised, node-negative tumors is good. Bladder reconstruction is achievable in most patients.
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Affiliation(s)
- Rajendra B Nerli
- 1Department of Urology, JN Medical College, KLE Academy of Higher Education and Research, JNMC Campus, Nehru Nagar, Belagavi, 590010 Karnataka India
| | - Shridhar C Ghagane
- Department of Urology, KLES Kidney Foundation, KLES Dr. Prabhakar Kore Hospital & Medical Research Centre, Nehru Nagar, Belagavi, 590010 Karnataka India
| | - Prasanna Ram
- 1Department of Urology, JN Medical College, KLE Academy of Higher Education and Research, JNMC Campus, Nehru Nagar, Belagavi, 590010 Karnataka India
| | - S S Shimikore
- 3Department of Surgery, JN Medical College, KLE Academy of Higher Education and Research, JNMC Campus, Nehru Nagar, Belagavi, 590010 Karnataka India
| | - Kumar Vinchurkar
- 4Department of Surgical Oncology, JN Medical College, KLE Academy of Higher Education and Research, JNMC Campus, Nehru Nagar, Belagavi, 590010 Karnataka India
| | - Murigendra B Hiremath
- 5Department of Biotechnology and Microbiology, Karnatak University, Dharwad, 580003 Karnataka India
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T4 Colon Cancer - Current Management. CURRENT HEALTH SCIENCES JOURNAL 2018; 44:5-13. [PMID: 30622748 PMCID: PMC6295185 DOI: 10.12865/chsj.44.01.01] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/20/2017] [Accepted: 01/05/2018] [Indexed: 12/11/2022]
Abstract
Colorectal cancer is the third most often encountered type of cancer and represents the third leading cause of cancer related deaths, on both sexes. One of the most important prognostic parameters is the tumor’s stage at the time of the diagnosis. T4 cancers represent advanced tumors associated with penetration of the visceral peritoneum (T4a) and/or direct invasion in adjacent structures (T4b). Preoperative diagnosis is influenced by the inability of the existent imaging modalities to accurately differentiate the true invasion from the simple, inflammatory adherence to the neighboring structures. As a consequence surgical treatment must follow the principle of en bloc resection; however the ability of achieving an R0 resection depends on the tumor location, invaded organ, and the type of the surgical procedure required. Neoadjuvant treatment for advanced colon cancer it may be very difficult to be applied. This review is focused on preoperative workup, therapeutic strategies and subsequent results in advanced T4 colon cancers.
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van den Heijkant F, Vermeer T, Vrijhof E, Nieuwenhuijzen G, Koldewijn E, Rutten H. Psoas hitch ureteral reimplantation after surgery for locally advanced and locally recurrent colorectal cancer: Complications and oncological outcome. Eur J Surg Oncol 2017; 43:1869-1875. [DOI: 10.1016/j.ejso.2017.05.018] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2016] [Revised: 05/15/2017] [Accepted: 05/15/2017] [Indexed: 10/19/2022] Open
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Helewa RM, Park J. Surgery for Locally Advanced T4 Rectal Cancer: Strategies and Techniques. Clin Colon Rectal Surg 2016; 29:106-13. [PMID: 27247535 PMCID: PMC4882171 DOI: 10.1055/s-0036-1580722] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Locally advanced T4 rectal cancer represents a complex clinical condition that requires a well thought-out treatment plan and expertise from multiple specialists. Paramount in the management of patients with locally advanced rectal cancer are accurate preoperative staging, appropriate application of neoadjuvant and adjuvant treatments, and, above all, the provision of high-quality, complete surgical resection in potentially curable cases. Despite the advanced nature of this disease, extended and multivisceral resections with clear margins have been shown to result in good oncological outcomes and offer patients a real chance of cure. In this article, we describe the assessment, classification, and multimodality treatment of primary locally advanced T4 rectal cancer, with a focus on surgical planning, approaches, and outcomes.
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Affiliation(s)
- Ramzi M. Helewa
- Department of Surgery, University of Ottawa, Ottawa, Ontario, Canada
| | - Jason Park
- Section of Surgical Oncology, Department of Surgery, University of Manitoba, Winnipeg, Manitoba, Canada
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