Annals of Coloproctology

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The Relationship of Depth of Penetration and Tumor Size to the Number of.: Hong, Dong Hwan , Kim, Heung Dae , Shin, Jun Ho , Han, Won Kon , Pae, Won Kil; J Korean Soc Coloproctol. 1997;13(3):343-352.

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Abstract PDF: We examined the interrelationships of depth of penetration, tumor size, and the number of positive lymph nodes in Dukes'c colorectal cancer. This report contains a retrospective study of 256 cases of colorectal cancer that underwent treatment from Jan. 1985 to Dec. 1994 at the Department of Surgery, Kangbuk Samsung Hospital. The most of the patients were on the 6th decades and male to female ratio was 1.27 : 1. By modified Astler-Coller classification, there were stage Cl 29 cases(11.3%), C2 227 cases(88.7%). Eighty patients with colon cancer(31.4%) and 176 patients with carcinoma of the rectum(68.6%) were available for analysis. Utilizing cumulative frequency distributions of tumor size, depth of invasion and the number of positive lymph nodes, comparisons were carried out among three factors. The results indicate that there was no correlation between the longest diameter of the tumor and other two factors but the number of positive lymph node was closely related to depth of invasion. In conclusion, the number of positive lymph node and depth of invasion are very important prognostic factor. But tumor size as a single factor does not correlated with prognosis in Dukes' C colorectal cancer.

Clinical Analysis of T4 Colorectal Cancer with Adhesion to Adjacent Organs.: Cho, Mun Hyeong , Joo, Jai Kyun , Ryu, Seong Yeob , Kim, Hyeong Rok , Kim, Dong Yi , Kim, Young Jin; J Korean Soc Coloproctol. 2003;19(5):290-298.

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Abstract PDF: PURPOSE
A colorectal cancer (CRC) is defined as T4 when the tumor directly invades other organs or structures and/or perforates the visceral peritoneum. The purpose of this study was to evaluate the results of a surgical approach and to determine the significant prognostic factors for tumor resectability and survival in patients with advanced T4 CRC.
METHODS
A total of 61 patients with T4 CRC with adjacent organ adhesion, who received multivisceral resections at Chonnam University Hospital, Korea, between Jan. 1990 and Dec. 2001, were analyzed retrospectively.
RESULTS
Cancer invasion to contiguous organs was present in 51 (83.6%) of the 61 patients who received a multivisceral resection and was absent in 10 (16.4%). Postoperative rates of complications and death were 22.9% and 4.9%, respectively, in the 61 patients. Lymph-node (LN) metastases were presented in 25 patients (41.0%). The 5-year survival rate (5 YSR) was 22.2% in patients with LN metastases, but was significantly higher (66.7%) in patients without LN metastases. The 5 YSRs for the 61 patients according to the AJCC cancer stage (TNM classification) were as follows: stage II (66.7%), stage III (46.4%), and stage IV (0%).
CONCLUSIONS
T4 CRC without distant metastases requires multivisceral en-bloc resection of any organ or structure to which the primary tumor is adhered. The presence of LN metastases at the time of surgery is one of the significant factors with a poor prognosis in T4 CRC.

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