Limiting the resectability in locally advanced primary or rec urrent carcinoma of the colon

Purpose : The terms of ‘unresectable’, ‘inoperable’ and ‘incurable’ cancer/patient are widely used but not clearly defined and thus subject to significant subjectivity. Where is the limit of ‘resectability’ of colorectal cancer - the criteria are variable and not precisely defined yet. Locally advanced lesion may vary from visible intimately adhered to the surrounding tissue, i.e. marginal, ‘border’ resectable tumour to one that directly macroscopically engages adjacent critical structures. This paper presents the experience of other foreign authors with their results in the determination of the tumour as resectable or unresectable as well as own clinical experience in this field. Material and methods : The study covered the patients with colorectal cancer who were operated in the Clinic of Surgery during a period of 9 years and retrospectively analyzed. Results : Out of a total of 1051 surgeries on the occasion of colorectal cancer, advanced disease constituted 28,6% or 301 patients. Of them, 52,5% were localized in different parts of the colon. Fifty-eight combined resections were performed as in 7 of them (recurrent tumours) R1 was accomplished, i.e. a non-radical result. A total of 117 cases were assessed intraoperatively as non-radical surgery and palliative procedures were performed such as resections (with or without restoration of the intestinal passage, but in the case of M1), bypass anastomoses, or simple interruption of the passage. . Conclusion : Many of the world’s leading surgical centres adopt the tactics of ‘adequate aggressive behaviour’ for locally advanced primary and recurrent colorectal cancer. In determining the reasonable balance between aggressive approach and the so-called meaningless ‘surgical exorbitance’ there is strive to adhere to the view that failure to achieve R0-resection planed in such an operation as well as leading performance or a combination of factors such as advanced age, severe co-morbidities, presence of complicated forms of colorectal cancer, urgent intervention and data of generalization of the malignant process undermine the performance of aggressive block removal of tumour formation. However, adequate pre- and intraoperative assessment and surgical experience should avoid ‘exaggerated’ intraoperative status of locally advanced tumour