Systematic Review
Copyright ©The Author(s) 2019. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Meta-Anal. Jun 30, 2019; 7(6): 269-289
Published online Jun 30, 2019. doi: 10.13105/wjma.v7.i6.269
Significance of multivisceral resections in oncologic surgery: A systematic review of the literature
Giorgi Nadiradze, Can Yurttas, Alfred Königsrainer, Philipp Horvath
Giorgi Nadiradze, Can Yurttas, Alfred Königsrainer, Philipp Horvath, Department of General, Visceral and Transplant Surgery, University of Tübingen, Comprehensive Cancer Center, Tübingen 72076, Germany
Philipp Horvath, National Center for Pleura and Peritoneum, Tübingen 72076, Germany
Author contributions: Nadiradze G and Yurttas C contributed equally to this work. Königsrainer A initiated the study and approved the final version of the manuscript; Nadiradze G and Yurttas C participated in developing the manuscript and approved the final version of the manuscript. Horvath P led the literature research, abstracted and analyzed the data and developed the manuscript.
Conflict-of-interest statement: We declare that we have no conflict of interest.
PRISMA 2009 Checklist statement: The authors have read the PRISMA 2009 Checklist, and the manuscript was prepared according to the PRISMA 2009 checklist.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See:
Corresponding author: Philipp Horvath, MD, Surgeon, Surgical Oncologist, Department of General, Visceral and Transplant Surgery, University of Tübingen, Comprehensive Cancer Center, Hoppe-Seyler-Strasse 3, Tübingen 72076, Germany.
Telephone: +49-7071-2986620 Fax: +49-7071-295588
Received: March 20, 2019
Peer-review started: March 20, 2019
First decision: May 16, 2019
Revised: June 7, 2019
Accepted: June 16, 2019
Article in press: June 17, 2019
Published online: June 30, 2019

Multivisceral resections (MVR) are often necessary to reach clear resections margins but are associated with relevant morbidity and mortality. Factors associated with favorable oncologic outcomes and elevated morbidity rates are not clearly defined.


To systematically review the literature on oncologic long-term outcomes and morbidity and mortality in cancer surgery a systematic review of the literature was performed.


PubMed was searched for relevant articles (published from 2000 to 2018). Retrieved abstracts were independently screened for relevance and data were extracted from selected studies by two researchers.


Included were 37 studies with 3112 patients receiving MVR for colorectal cancer (1095 for colon cancer, 1357 for rectal cancer, and in 660 patients origin was not specified). The most common resected organs were the small intestine, bladder and reproductive organs. Median postoperative morbidity rate was 37.9% (range: 7% to 76.6%) and median postoperative mortality rate was 1.3% (range: 0% to 10%). The median conversion rate for laparoscopic MVR was 7.9% (range: 4.5% to 33%). The median blood loss was lower after laparoscopic MVR compared to the open approach (60 mL vs 638 mL). Lymph-node harvest after laparoscopic MVR was comparable. Report on survival rates was heterogeneous, but the 5-year overall-survival rate ranged from 36.7% to 90%, being worst in recurrent rectal cancer patients with a median 5-year overall survival of 23%. R0 -resection, primary disease setting and no lymph-node or lymphovascular involvement were the strongest predictors for long-term survival. The presence of true malignant adhesions was not exclusively associated with poorer prognosis.

Included were 16 studies with 1.600 patients receiving MVR for gastric cancer. The rate of morbidity ranged from 11.8% to 59.8%, and the main postoperative complications were pancreatic fistulas and pancreatitis, anastomotic leakage, cardiopulmonary events and post-operative bleedings. Total mortality was between 0% and 13.6% with an R0 -resection achieved in 38.4% to 100% of patients. Patients after R0 resection had 5-year overall survival rates of 24.1% to 37.8%.


MVR provides, in a selected subset of patients, the possibility for good long-term results with acceptable morbidity rates. Unlikelihood of achieving R0 -status, lymphovascular- and lymph -node involvement, recurrent disease setting and the presence of metastatic disease should be regarded as relative contraindications for MVR.

Keywords: Colorectal cancer, Gastric cancer, Primary, Recurrent, Multivisceral resection, Hyperthermic intraperitoneal chemotherapy, Morbidity

Core tip: Multivisceral resections constitute a huge challenge for an interdisciplinary team. Proper patient selection, combined perioperative systemic treatment and en-bloc resection of adherent organs can provide acceptable morbidity-, mortality- and long-term survival rates.