Long-term follow-up after surgery for advanced colorectal carcinoma involving the urogenital tract.

OBJECTIVES: Advanced colorectal carcinomas frequently involve the urogenital tract. In the following we evaluate the long-term survival after radical surgical extirpation and the prognostic significance of involvement of specific urological organs.

METHODS: Between January 1985 and April 1996, 101 patients underwent interdisciplinary tumour extirpation of an advanced colorectal carcinoma involving the urogenital tract.

RESULTS: Of 68 men and 33 women, 40 presented with primary and 61 with recurrent carcinoma. As far as urological organs are concerned, the ureter was removed in 82 patients, followed by bladder (n=52), seminal vesicles (n=25), prostate (n=22), kidney, testicle and penis. Histology revealed cancerous infiltration in 52% of the organs resected. A negative surgical margin was obtained in 54% of the patients, 43% showed positive lymph nodes. There was a 41% peri-operative complication with a mortality rate of 5%. Five year overall survival was 24.4% (median 23 months) with prognostic factors being type of tumour (primary versus recurrent), surgical margin and lymph node status. Stratification according to these factors showed removal of bladder and prostate to be a favourable and ureteral removal to be an omnious factor.

CONCLUSION: We conclude that multivisceral extirpation of advanced colorectal carcinomas involving the urogenital tract should be recommended in selected patients. Our data showed it to be a safe surgical procedure, which is associated with favourable long-term outcome in non-metastatic patients in whom complete surgical resection could be achieved.