Surgical innovation redefines what is possible for advanced colorectal cancer

Editor's Note

Colorectal tumors once considered inoperable are now routinely treated with curative surgery, thanks to advances in multimodality therapy and complex resection techniques, Mayo Clinic September 16 reports. Decades ago, cancers invading the sacrum, pelvic organs, or major blood vessels were often deemed unresectable, leaving patients with only palliative options. Today, improved chemotherapy, radiation, and surgical innovation mean it is now rare for surgeons to declare a tumor unresectable.

Eric J. Dozois, MD, chair of Colon and Rectal Surgery at Mayo Clinic, emphasized the importance of evaluation at specialized centers where surgical teams can achieve negative margin (R0) resections. Resections involving the aortoiliac axis can be paired with vascular reconstruction using deceased donor grafts, yielding 4-year survival outcomes comparable to less complex cases. Sacropelvic resections, sometimes extending to the L4 vertebra, achieved a 93% R0 rate in one 30-patient series, with 5-year survival near 45%, though some patients required long-term mobility assistance or amputation. For pelvic sidewall tumors, a Mayo-developed two-stage posterior-to-anterior technique increased R0 rates from roughly 60% to 100% in a 2024 study of 10 patients.

Mayo also incorporates intraoperative radiation therapy (IORT). A 2008 study of 146 patients showed negative margins in 68% of cases and 5-year overall survival above 50%, far exceeding historical expectations. IORT remains limited to select centers but continues to be a cornerstone of Mayo’s program, supported by state-of-the-art linear accelerator technology.

Successful treatment of locally advanced colorectal cancer requires extensive multidisciplinary collaboration, the outlet noted. Depending on the tumor’s reach, surgical teams may draw on expertise from gynecology, orthopedics, plastics, urology, and vascular surgery. This collaborative model has enabled curative surgery in cases once considered beyond reach, even when resectable metastatic disease is present.

While outcomes have improved, these operations are lengthy and high risk. Mayo surgeons emphasize detailed patient counseling about potential complications and quality-of-life tradeoffs. Cancer psychologists often assist in decision-making. Postoperative care includes rehabilitation, pain management, survivorship programs, and support for patients coping with functional changes. For those traveling long distances, Mayo coordinates with local providers to extend recovery resources at home.