Development of a pelvic exenteration service at a tertiary referral centre

Dickfos, Marilla; Tan, Stéphanie; Stevenson, Andrew; Harris, Chas. K.; Esler, Rachel; Peters, Matthew; Taylor, David G.

doi:10.1111/ans.14427

Cited by 9 publications

(13 citation statements)

References 18 publications

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“…There are now four colorectal surgeons involved, approximately 250 referrals per year and 80 resections performed per year. In Brisbane, 61 patients underwent exenteration in approximately 5 years before the study [7].…”

Section: Resultsmentioning

confidence: 99%

Human factors in pelvic exenteration: themes in high‐performing teams

Pal,

Chittleborough,

McCombie

et al. 2023

Colorectal Disease

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AimThe aim of this study was to investigate the role of human factors in pelvic exenteration and how team performance is optimized in the preoperative, intraoperative and postoperative phases.MethodQualitative analysis of focus groups was used to capture authentic human interactions that reflect real‐world multiprofessional performance. Theatre teams were treated as clusters, with a particular focus group containing participants who worked together regularly.ResultsThree focus groups were conducted. Four themes emerged – driving force, technical skills, nontechnical skills and operational aspects – with a total of 16 subthemes. Saturation was reached by group 2, with no new subthemes emerging after this. There was some interaction between the themes and the subthemes. Broadly speaking, driving force led to the development of specialised technical skills and nontechnical skills, which were operationalized into successful service through operational aspects.ConclusionThis study of teams performing pelvic exenteration is the first in the field using this methodology. It has generated rich qualitative data with authentic insights into the pragmatic aspects of developing and delivering a service. In addition, it shows how the themes are connected or ‘coupled’ in a network, for example technical and non‐technical skills. In a complex system, ‘tight coupling’ leads to both high performance and adverse events. In this paper, we report the qualitative aspects of high performance by pelvic exenteration teams in a complex sociotechnical system, which depends on tight coupling of several themes.

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Section: Resultsmentioning

confidence: 99%

Human factors in pelvic exenteration: themes in high‐performing teams

Pal,

Chittleborough,

McCombie

et al. 2023

Colorectal Disease

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“…during the establishment phase of a dedicated tertiary service. 5 In their reviewed cases including 34 locally advanced, 25 recurrent pelvic tumours and two non-neoplastic pathologies, there was a 91.5% R0 resection rate, 52.5% overall complication rate, 26.2% rate of Clavien-Dindo IIIb complications, 3.3% 30day mortality and 8% 12 month mortality rate. 5 Traeger et al (Adelaide, 2022) in their cohort of 113 patients (between 2008 and 2021) also demonstrated improvement in outcomes post development of a dedicated pelvic exenteration service, including higher rates of R0 resection (93.9% versus 84.2%) and lower rates of Clavien-Dindo grade IV complications (8.5 versus 31.3%).…”

Section: Discussionmentioning

confidence: 98%

Pelvic exenteration surgery outcomes following establishment of a Complex Pelvic Surgery multidisciplinary tertiary unit

Mackowski,

Limmer,

Lata

et al. 2023

Preprint

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Background: Pelvic exenteration surgery (PES) is a complex operation associated with significant morbidity. PES requires sub-specialised multidisciplinary input along with expertise in complex pelvic surgery and anatomy. The majority of published data on PES comes from high volume units, however there is emerging evidence of acceptable short and long-term outcomes in lower volume units where dedicated multidisciplinary teams are established. This study reports outcomes of PES in a lower volume centre with a collaborative multidisciplinary surgical approach. Methods: A retrospective review of patients who underwent PES for benign or malignant pathology at Liverpool and Macquarie University Hospitals between September 2015 and June 2022. Descriptive statistics were performed and Kaplan-Meier survival analysis for patients treated for malignancy with curative intent. Results: A total of 67 patients undergoing pelvic exenteration were included (53.8% female; with mean age 59 years). Indications for PES were colorectal cancer (56.7%), gynaecological cancer (22.4%), other malignancy (9.0%) and complex benign pathology (11.9%). Posterior or total pelvic exenteration was performed in 88.1%. Median hospital stay 16 days. Clavien-Dindo grade III or IV complications occurred in 34.3%. There were two post-operative deaths (3.0%; one palliative intent). For patients treated with curative intent (n=51), R0 resection margin was achieved in 92.2%, and R1 margin in 7.8%. Estimated five year disease-free survival was 57.1%, and five year overall survival was 65.5%. Conclusion: Short and long-term outcomes of PES in a low volume unit with appropriate multidisciplinary expertise are comparable to published data on pelvic exenteration from higher volume units.

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“…These early technical approaches and multidisciplinary collaboration with local surgeons, anaesthetists, oncologists, radiologists, led to early promising results 27 . More recently, these collaborations have led to the development of exenteration centres in Brisbane, 28 Auckland, and Adelaide 29 . This is a testament to collegiality, ensuring early experiences and mistakes are minimized, and training is provided to local exenteration surgeons.…”

Section: Discussionmentioning

confidence: 99%

Surgical, survival and quality of life outcomes in over 1000 pelvic exenterations: lessons learned from a large Australian case series

Steffens

Solomon

Lee

et al. 2023

ANZ Journal of Surgery

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Background: To determine surgical, survival and quality of life outcomes across different tumour streams and lessons learned over 28 years. Methods: Consecutive patients undergoing pelvic exenteration at a single, high volume, referral hospital, between 1994 and 2022 were included. Patients were grouped according to their tumour type at presentation as follows, advanced primary rectal cancer, other advanced primary malignancy, locally recurrent rectal cancer, other locally recurrent malignancy and non-malignant indications. The main outcomes included, resection margins, postoperative morbidity, long-term overall survival, and quality of life outcomes. Non-parametric statistics and survival analyses were performed to compare outcomes between groups. Results: Of the 1023 pelvic exenterations performed, 981 (95.9%) unique patients were included. Most patients underwent pelvic exenteration due to locally recurrent rectal cancer (N = 321, 32.7%) or advanced primary rectal cancer (N = 286, 29.2%). The rates of clear surgical margins (89.2%; P < 0.001) and 30-days mortality were higher in the advanced primary rectal cancer group (3.2%; P = 0.025). The 5-year overall survival rates were 66.3% in advanced primary rectal cancer and 44.6% in locally recurrent rectal cancer. Quality of life outcomes differed across groups at baseline, but generally had good trajectories thereafter. International benchmarking revelled excellent comparative outcomes. Conclusions: The results of this study demonstrate excellent outcomes overall, but significant differences in surgical, survival and quality of life outcomes across patients undergoing pelvic exenteration due to different tumour streams. The data reported in this manuscript can be utilized by other centres as benchmarking as well as proving both subjective and objective outcome details to support informed decision-making for patients.

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Development of a pelvic exenteration service at a tertiary referral centre

Abstract: Our experience confirms that radical resectional pelvic surgery can be safely performed with acceptable results during the establishment phase of a dedicated tertiary service.

Cited by 9 publications

References 18 publications

Human factors in pelvic exenteration: themes in high‐performing teams

Human factors in pelvic exenteration: themes in high‐performing teams

Pelvic exenteration surgery outcomes following establishment of a Complex Pelvic Surgery multidisciplinary tertiary unit

Surgical, survival and quality of life outcomes in over 1000 pelvic exenterations: lessons learned from a large Australian case series

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