Factors affecting outcomes following pelvic exenteration for locally recurrent rectal cancer

Kelly, Michael E.; Glynn, R; Aalbers, Arend G. J.; Abraham-Nordling, Mirna; Alberda, Wijnand J.; Antoniou, Anthony; Austin, Kirk K. S.; Beets, Geerard L.; Beynon, J.; Bosman, S.; Brunner, Maximilian; Büchler, Markus W.; Burger, Jacobus W. A.; Campain, Nicholas; Christensen, Henrik; Codd, Mary; Coscia, Maurizio; Colquhoun, A J; Daniels, IR; Davies, Richard J.; Wilt, Johannes H. W. de; Deutsch, C; Dietz, David W.; Eglinton, Tim; Fearnhead, N.; Frizelle, Frank; García-Sabrido, J.L.; George, Mark; Gentilini, Lorenzo; Harris, Dean; Harji, Deena; Heriot, Alexander G.; Brunner, W; Jenkins, John T.; Kanemitsu, Yukihide; Chan, Karen Kl; Kim, H; Koh, Cherry; Kok, Niels F. M.; Kontovounisios, Christos; Kulu, Yakup; Law, Wai‐Lun; Lê, Giao; Lee, P; Lydrup, Marie‐Louise; Lynch, A. C.; Martling, Anna; Meijerink, Jeroen; Merkel, Susanne; McDermott, Frank; McGrath, John; Christensen, Mariann; Nieuwenhuijzen, G.A.P.; Nordling, Margareta; Northover, John; O’Connell, P. R.; Patsouras, Dimitrios; Poggioli, Gilberto; Radwan, Rami; Rasheed, Shahnawaz; Rasmussen, Peter; Rothbarth, Joost; Rutten, H.J.T.; Sagar, P. M.; Schizas, Alexis; Shida, Dai; Smart, NJ; Solomon, Michael J.; Stocchi, Luca; Tekkis, Paris; Tsukamoto, Shunsuke; Turner, William H.; Tuynman, Jurriaan B.; Ulrich, Alexis; Leeuwenhoek, Antoni Van; Ramshorst, Gabriëlle H. van; Vásquez-Jiménez, W; Verhoef, Cornelis; Versteegen, M; Wakeman, Chris; Warrier, Satish; Yip, Jeremy; Winter, D. C.

doi:10.1002/bjs.10734

Cited by 161 publications

(59 citation statements)

References 35 publications

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“…Since the first description of PE for gynaecologic cancer in 1948[6,24], the procedure has been adopted with increasing success rates in patients with rectal cancer[8,12-14,25-27]. The PE of colorectal interest involves “ en bloc ” resection of the cancer and of the surrounding structures/organs, namely, the rectum, distal colon, internal reproductive organs, draining lymph in posterior PE (also known as composite resections) or bladder, lower ureters, rectum, distal colon, sacrum, reproductive organs, draining lymph nodes and peritoneum in total PE[6,28].…”

Section: Discussionmentioning

confidence: 99%

“…PE for rectal cancer brings higher risks of complications, ranging from 25% to 42%[5,8,11], with studies reporting higher rates when PE for other-than-rectal cancers is included[12]. The high incidence of complications is downplayed by the survival benefits obtained by excision of the pelvic mass with microscopically negative margins (R0)[7,8,12-14]. Few studies have focused on the outcomes of PE in locally advanced primary rectal cancer (LAPRC), although an increasing number of patients are being offered this extensive procedure.…”

Section: Introductionmentioning

confidence: 99%

“…Few studies have focused on the outcomes of PE in locally advanced primary rectal cancer (LAPRC), although an increasing number of patients are being offered this extensive procedure. A recent study of the PelvEx Collaborative found that the median life expectancy after curative PE for LAPRC surpasses 40 mo, but median survival after resections with macroscopically involved margins drops to less than one year[14].…”

Section: Introductionmentioning

confidence: 99%

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Pelvic exenterations for primary rectal cancer: Analysis from a 10-year national prospective database

Pellino

Biondo

Cazador

et al. 2018

WJG

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AIMTo identify short-term and oncologic outcomes of pelvic exenterations (PE) for locally advanced primary rectal cancer (LAPRC) in patients included in a national prospective database.METHODSFew studies report on PE in patients with LAPRC. For this study, we included PE for LAPRC performed between 2006 and 2017, as available, from the Rectal Cancer Registry of the Spanish Association of Surgeons [Asociación Española de Cirujanos (AEC)]. Primary endpoints included procedure-associated complications, 5-year local recurrence (LR), disease-free survival (DFS) and overall survival (OS). A propensity-matched comparison with patients who underwent non-exenterative surgery for low rectal cancers was performed as a secondary endpoint.RESULTSEight-two patients were included. The mean age was 61.8 ± 11.5 years. More than half of the patients experienced at least one complication. Surgical site infections were the most common complication (abdominal wound 18.3%, perineal closure 19.4%). Thirty-three multivisceral resections were performed, including two hepatectomies and four metastasectomies. The long-term outcomes of the 64 patients operated on before 2013 were assessed. The five-year LR was 15.6%, the distant recurrence rate was 21.9%, and OS was 67.2%, with a mean survival of 43.8 mo. R+ve resection increased LR [hazard ratio (HR) = 5.58, 95%CI: 1.04-30.07, P = 0.04]. The quality of the mesorectum was associated with DFS. Perioperative complications were independent predictors of shorter survival (HR = 3.53, 95%CI: 1.12-10.94, P = 0.03). In the propensity-matched analysis, PE was associated with better quality of the specimen and tended to achieve lower LR with similar OS.CONCLUSIONPE is an extensive procedure, justified if disease-free margins can be obtained. Further studies should define indications, accreditation policy, and quality of life in LAPRC.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Pelvic exenterations for primary rectal cancer: Analysis from a 10-year national prospective database

Pellino

Biondo

Cazador

et al. 2018

WJG

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“…The goal in rectal cancer treatment is to optimize disease-free and overall survival, while minimizing the risk of locally recurrent rectal cancer (LRRC) [ 4 , 5 , 6 , 7 ]. LRRC is defined as recurrence of rectal cancer within the pelvis after previous standard treatment [ 8 ]. A wide range of LRRC rates after operation for rectal cancer are reported [ 9 ].…”

Section: Purposementioning

confidence: 99%

Image-guided high-dose-rate interstitial brachytherapy technique for locally recurrent rectal cancer in perineum

Gao¹,

Wu²,

Zhao³

et al. 2018

jcb

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PurposeThe aim of the report was the evaluation of application with image-guided high-dose-rate (HDR) interstitial brachytherapy in patients undergoing conventional chemo-radiotherapy for perineal locally recurrent rectal cancer (LRRC).Material and methods75-year-old female patient presented with LRRC three years after total mesorectal excision (TME) surgery for rectal cancer with tubular adenocarcinoma (stage IIIB). Despite conventional chemotherapy and external beam radiotherapy, the re-recurrent lesion expanded as 4.5 × 5.5 cm2 located in perineum with skin invasion. The loco-regional recurrent tumor was treated with HDR interstitial brachytherapy under ultrasound guidance and magnetic resonance imaging-based treatment planning. The brachytherapy dose was 50 Gy in 10 fractions of 5 Gy each for 5 weeks.ResultsRemoval of the perineal LRRC was securely achieved by image-guided HDR interstitial brachytherapy technique. The refractory tumor healed uneventfully after interstitial brachytherapy without recurrence during 26 months of follow-up. The patient had good quality of life without serious complications of treatment.ConclusionsImage-guided HDR interstitial brachytherapy in selected patient with LRRC in perineum is a proven, effective, and safe treatment method with relatively long-term outcome.

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“…The Pelvex Collaborative published the weight of different factors on long-term survival after bTME, and neoadjuvant therapy was associated with higher rates of readmission [10], but other variables were not taken into account. Aim of this study is to specifically investigate the role played by patient-related and surgery-related factors in the 30-day readmission rate after bTME procedures.…”

Section: Introductionmentioning

confidence: 99%

Predictors of short-term readmission after beyond total mesorectal excision for primary locally advanced and recurrent rectal cancer

et al. 2019

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Unplanned readmissions heavily affect the cost of health care and are used as an indicator of performance. No clear data are available regarding beyond-total mesorectal excision (bTME) procedure. Aim of the study is to identify patient-related and surgery-related factors influencing the 30-day readmissions after bTME. Retrospective data were collected from 220 patients who underwent bTME procedures at single centre between 2006 and 2016. Patient-related and operative factors were assessed, including body mass index (BMI), age, gender, American Society of Anaesthesiologists’ (ASA) score, preoperative stage, neo-adjuvant therapy, primary tumour vs recurrence, the extent of surgery. The readmission rate was 8.18%. No statistically significant association was found with BMI, ASA score, length of stay and stay in the intensive care unit, primary vs recurrent tumour or blood transfusions. Not quite statistically significant was the association with pelvic side wall dissection (OR 3.32, p = 0.054). Statistically significant factors included preoperative stage > IIIb (OR: 4.77, p = 0.002), neo-adjuvant therapy (OR: 0.13, p = 0.0006), age over 65 years (OR: 5.96, p = 0.0005), any re-intervention during the first admission (OR: 7.4, p = 0.0001), and any post-operative complication (OR: 9.01, p = 0.004). The readmission rate after beyond-TME procedure is influenced by patient-related factors as well as post-operative morbidity. Electronic supplementary material The online version of this article (10.1007/s13304-019-00669-6) contains supplementary material, which is available to authorized users.

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Factors affecting outcomes following pelvic exenteration for locally recurrent rectal cancer

Cited by 161 publications

References 35 publications

Pelvic exenterations for primary rectal cancer: Analysis from a 10-year national prospective database

Pelvic exenterations for primary rectal cancer: Analysis from a 10-year national prospective database

Image-guided high-dose-rate interstitial brachytherapy technique for locally recurrent rectal cancer in perineum

Predictors of short-term readmission after beyond total mesorectal excision for primary locally advanced and recurrent rectal cancer

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