EP593 - Pelvic En-bloc Multivisceral Resection for Primary Locally Advanced Colorectal Cancer: Clinical and Oncologic Outcomes

ePoster Presenter(s)

• 

  Hye-Jin Kim, MD

  Associate professor
  Kyungpook National University Chilgok Hospital
  Kyungpook National University
  Daegu, Kyongsang-bukto, Republic of Korea

  All disclosed relationships have been reviewed and managed prior to the start of this activity. Any relevant relationships will be listed below. This individual has no financial relationships to disclose

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Author(s)

• 

  Seungho Song

  Assistant professor
  Kyungpook National University Hospital
  Kyungpook National University
  Daegu, Taegu-jikhalsi, Republic of Korea

  Disclosure information not submitted.
• 

  Jun Seok Park, MD, PhD

  professor
  Kyungpook National University Chilgok Hospital
  Kyungpook National University
  Dae Ku, Taegu-jikhalsi, Republic of Korea

  All disclosed relationships have been reviewed and managed prior to the start of this activity. Any relevant relationships will be listed below. This individual has no financial relationships to disclose
• SP

  Soo-Yeun Park, n/a

  Associate Professor
  Kyungpook National University Chilgok Hospital
  Taegu, Taegu-jikhalsi, Republic of Korea

  Disclosure information not submitted.

Senior Author(s)

• GC

  Gyu-Seog Choi, Colorectal surgeon

  Professor
  Kyungpook national university chilgok hospital
  Daegu, Taegu-jikhalsi, Republic of Korea

  Disclosure information not submitted.

Purpose/Background: With advances in multimodal therapy, en-bloc multivisceral resection (MVR) has become an essential component in achieving curative resection for locally advanced colorectal cancer. This study aimed to evaluate perioperative and oncologic outcomes following pelvic en-bloc MVR for primary colorectal cancer.

Methods/Interventions: Between 2011 and 2024, 139 patients underwent curative-intent pelvic en-bloc MVR for primary colorectal cancer at a single tertiary center. Demographic, perioperative, and pathological outcomes were retrospectively reviewed. Disease-free survival (DFS), local recurrence-free survival (LRFS), and overall survival (OS) were estimated using the Kaplan-Meier method.

Results/Outcomes: Of 139 patients, 83 (59.7%) had rectal cancer and 106 (76.3%) received neoadjuvant therapy. A minimally invasive approach (laparoscopic or robotic) was used in 62.6% of cases, and abdominoperineal resection was performed in 18%. The anterior compartment was most commonly resected (n=85), while 51 patients required multi-compartment resection and 23 underwent pelvic exenteration. Over time, minimally invasive approach became more frequent except in cases requiring total exenteration. Major postoperative complications (Clavien-Dindo ≥ III) occurred in 17.3%, most commonly urinary complications. Pathologic T4b disease was identified in 75 patients, and 17 rectal cancer patients had circumferential resection margin ≤1 mm. At a median follow-up of 51 months, 3-year DFS, LRFS, and OS were 80.8%, 93.4%, and 92.2%, respectively. Local recurrence developed in 11 patients (6.5%), predominantly in lower rectal cancers.

Conclusion/Discussion: Pelvic en-bloc MVR offers favorable oncologic outcomes with acceptable morbidity in carefully selected patients with locally advanced colorectal cancer, particularly when integrated with neoadjuvant therapy. The increasing adoption of minimally invasive techniques demonstrates their feasibility and expanding role in complex pelvic resections.

Figure 1.
(A) Resected compartments during pelvic en-bloc multivisceral resection.

(B) Changes in the proportion of patients receiving neoadjuvant therapy and minimally invasive approaches over time.

(C) Robotic abdominoperineal resection with en-bloc vaginectomy, combined with bilateral lateral pelvic node dissection and inguinal lymph node dissection.