Abstract
Colorectal cancer is one of the most common malignant diseases in developed countries, its incidence is increasing. In the Czech Republic is incidence very high and it is, excluding all skin cancers, on the first place in all cancers.
Advanced colorectal cancer, unfortunately, affects a considerable proportion of our population. Emerging opportunities of multimodality treatment significantly improve the prognosis of these patients.
The only chance for long term survival is radical surgical resection. For locally advanced tumors is multiorgan resection indicated.
In the case of metastatic disease, both liver and lungs, we must always consider the possibility of resection of these metastases. In case of synchronous metastases we can performe simultaneous resection or staged resection.
Liver first approach is prefered recently. In the case of metastatic peritoneal dissemination we must consider cytoreductive surgery and HIPEC, although the resectability of such involvement is low.
When deciding on multiple organ resection, pelvic exenteration, resection of liver or lung metastases, cytoreductive surgery or HIPEC we consider overall assessment findings, all available tests and overall condition of the patient in a multidisciplinary team (MDT). All patients with advanced colorectal cancer should be discussed in these teams, even though it seems to be primarily inoperable.