A systematic review of the pathological determinants of outcome following resection by pelvic exenteration of locally advanced and locally recurrent rectal cancer

Gould, Laura E.; Pring, Edward; Drami, Ioanna; Moorghen, Morgan; Naghibi, M.; Jenkins, John T.; Steele, Colin W.; Roxburgh, Campbell S.D.

doi:10.1016/j.ijsu.2022.106738

Cited by 8 publications

(9 citation statements)

References 57 publications

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“…16 MDT discussion facilitates careful selection of patients to undergo pelvic exenteration and, with thorough surgical planning, may reduce the risk of positive resection margins known to negatively impact disease prognosis and survival outcomes. 19,20 While the long-term impact of patient discussion at the dedicated SA state-wide pelvic exenteration MDT is yet to be determined, the role of specialized MDT meetings in cancer patient management undoubtedly improves surgical outcomes and R0 resection rates, resulting in better patient satisfaction and ultimately overall survival. 6,17,21 Conversely, referral to a specialized MDT with recommendation for non-surgical palliative intent treatment could prevent unnecessary surgery and morbidity in patients who do not stand to benefit from surgery.…”

Section: Discussionmentioning

confidence: 99%

“…The high positive margin rates in patients with T4 rectal cancers undergoing multi‐visceral resection highlights the need for this type of discussion to improve outcomes for an at‐risk patient group 16 . MDT discussion facilitates careful selection of patients to undergo pelvic exenteration and, with thorough surgical planning, may reduce the risk of positive resection margins known to negatively impact disease prognosis and survival outcomes 19,20 . While the long‐term impact of patient discussion at the dedicated SA state‐wide pelvic exenteration MDT is yet to be determined, the role of specialized MDT meetings in cancer patient management undoubtedly improves surgical outcomes and R0 resection rates, resulting in better patient satisfaction and ultimately overall survival 6,17,21 .…”

Section: Discussionmentioning

confidence: 99%

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Establishing a state‐wide pelvic exenteration multidisciplinary team meeting in South Australia

Fitzsimmons

Thomas

Tonkin

et al. 2022

ANZ Journal of Surgery

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Background Pelvic exenteration surgery is complex, necessitating co‐ordinated multidisciplinary input and improved referral pathways. A state‐wide pelvic exenteration multidisciplinary team (MDT) meeting was established in SA and the outcomes of this were audited and compared with historical data. Methods All patients referred for discussion between August 2021 and July 2022 to the SA State‐wide Pelvic Exenteration MDT were included in this study. MDT discussion centred around disease resectability, risk versus benefit of surgery, and need for local or interstate referral. Prospective data collection included patient demographics and MDT recommendations of surgery, palliation, or referral. Patients referred for surgery locally or interstate were compared with a retrospective patient cohort treated previously between January and December 2020. Results Over 12 months, 91 patients were discussed (including nine multiple times), by a mean of 18 meeting participants each month. Forty‐eight patients (58.5%) had primary malignancy, 25 (30.5%) recurrent malignancy, and 9 (11.0%) had non‐malignant disease. Colorectal cancer was the most common presentation (56.1%), followed by gynaecological (30.5%) and urological (6.1%) malignancy. Pelvic exenteration surgery was recommended to be performed locally in 53.7% of patients and the remainder for non‐surgical treatment, palliation, or re‐discussion. During this time, 44 patients underwent surgery locally (versus 34 in 2020) and only 4 referred interstate (versus 8 in 2020). Conclusion The establishment of a dedicated state‐wide pelvic exenteration MDT has resulted in better coordination of care for patients with locally advanced pelvic malignancy in SA, and significantly reduced the need for interstate referral.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Establishing a state‐wide pelvic exenteration multidisciplinary team meeting in South Australia

Fitzsimmons

Thomas

Tonkin

et al. 2022

ANZ Journal of Surgery

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“…Numerous studies and regionalized groups have highlighted the importance of achieving a negative margin (R0) [4–6]. This is well established to be the ‘holy grail’ of exenterative surgery, as it is the greatest predictor of long‐term survival [4–7].…”

Section: Introductionmentioning

confidence: 99%

“…

Radical surgery remains the mainstay of curative treatment for locally advanced and locally recurrent rectal cancer (LARC and LRRC, respectively) [1]. Improved techniques, protocolized perioperative care and advances in adjuvant therapies have led to an increase in the number of patients being considered for surgery [2, 3].Proportionately, there has been an increase in research relating to pelvic exenterative surgery.Numerous studies and regionalized groups have highlighted the importance of achieving a negative margin (R0) [4][5][6]. This is well established to be the 'holy grail' of exenterative surgery, as it is the

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mentioning

confidence: 99%

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Contemporary results from the PelvEx collaborative: improvements in surgical outcomes for locally advanced and recurrent rectal cancer

2024

Colorectal Disease

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AimThe PelvEx Collaborative collates global data on outcomes following exenterative surgery for locally advanced and locally recurrent rectal cancer (LARC and LRRC, respectively). The aim of this study is to report contemporary data from within the collaborative and benchmark it against previous PelvEx publications.MethodAnonymized data from 45 units that performed pelvic exenteration for LARC or LRRC between 2017 and 2021 were reviewed. The primary endpoints were surgical outcomes, including resection margin status, radicality of surgery, rates of reconstruction and associated morbidity and/or mortality.ResultsOf 2186 patients who underwent an exenteration for either LARC or LRRC, 1386 (63.4%) had LARC and 800 (36.6%) had LRRC. The proportion of males to females was 1232:954. Median age was 62 years (interquartile range 52–71 years) compared with a median age of 63 in both historical LARC and LRRC cohorts. Compared with the original reported PelvEx data (2004–2014), there has been an increase in negative margin (R0) rates from 79.8% to 84.8% and from 55.4% to 71.7% in the LARC and LRRC cohorts, respectively. Bone resection and flap reconstruction rates have increased accordingly in both cohorts (8.2%–19.6% and 22.6%–32% for LARC and 20.3%–41.9% and 17.4%–32.1% in LRRC, respectively). Despite this, major morbidity has not increased.ConclusionIn the modern era, patients undergoing pelvic exenteration for advanced rectal cancer are undergoing more radical surgery and are more likely to achieve a negative resection margin (R0) with no increase in major morbidity.

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Dutch national guidelines for locally recurrent rectal cancer

Piqeur,

Creemers,

Banken

et al. 2024

Cancer Treatment Reviews

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A systematic review of the pathological determinants of outcome following resection by pelvic exenteration of locally advanced and locally recurrent rectal cancer

Abstract: A systematic review of the pathological determinants of outcome following resection by pelvic exenteration of locally advanced and locally recurrent rectal cancer.

Cited by 8 publications

References 57 publications

Establishing a state‐wide pelvic exenteration multidisciplinary team meeting in South Australia

Establishing a state‐wide pelvic exenteration multidisciplinary team meeting in South Australia

Contemporary results from the PelvEx collaborative: improvements in surgical outcomes for locally advanced and recurrent rectal cancer

Dutch national guidelines for locally recurrent rectal cancer

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