Total pelvic exenteration for rectal cancer: outcomes and prognostic factors

Abstract

Background:To perform complete resection of locally advanced and recurrent rectal carcinoma, total pelvic exenteration (TPE) may be attempted. We identified disease-related outcomes and prognostic factors. Methods:We conducted a single-centre review of patients who underwent TPE for rectal carcinoma over a 10-year period. Results:We included 28 patients in our study. After a median follow-up of 35 months, 53.6% of patients were alive with no evidence of disease. The 3-year actuarial disease-free and overall survival rates were 52.2% and 75.1%, respectively. On univariate analysis, recurrent disease, preoperative body mass index greater than 30 and lymphatic invasion were poor prognostic factors for disease-free survival, and only lymphatic invasion predicted overall survival. Additionally, multivariate analysis identified lymphatic invasion as an independent poor prognostic factor for disease-free survival in this patient population with locally advanced and recurrent rectal carcinoma. Conclusion:Despite the significant morbidity, TPE can provide long-term survival in patients with rectal carcinoma. Additionally, lymphatic invasion on final pathology was an independent prognostic factor for disease-free survival.Contexte : Pour pratiquer une résection complète du cancer du rectum avancé au stade local et récidivant, on peut tenter une exentération pelvienne totale (EPT). Nous avons déterminé des résultats liés à la maladie et des facteurs de pronostic. Méthodes :Nous avons procédé à une étude unicentrique portant sur des patients qui ont subi une EPT pour un cancer du rectum au cours d'une période de 10 ans.

Layer-oriented total pelvic exenteration for locally advanced primary colorectal cancer

“…The perioperative mortality following TPE has decreased from as high as 20 % before 2000 [9,10] to less than 5 % in recently reported case series [7,11,12]. In the present series, one operative death was noted in the earlier period, but there Fig.…”

“…In recent reports, postoperative complication rates after TPE for primary tumors have been reported to range from 26 % [11] to 68 % [12]; the present series did not show a high rate of postoperative complications. Pathologically curative resection (R0) was achieved in 96 % of cases, which was no worse than reported in recent years, as 66 % [13], 71 % [12], and 75 % [7].…”

“…In addition, TPE is not frequently indicated in female patients when compared to male patients, so that female cases that required TPE had quite advanced stage tumors; this seems to explain why female sex was associated with a poorer prognosis. Positive nodal metastases [7,14] and pathological tumor stage T4 [15] have been accepted as factors associated with a poor prognosis in TPE.…”

“…Among the 13 cases whose diverting stomas were successfully taken down, the median Jeorge-Wexner incontinence score [5] at 1-year post operation was 8 [4][5][6][7][8][9][10][11][12][13][14], which was no worse than that of very low anterior resection. Among the 18 cases that underwent neobladder reconstruction, 15 cases voided urine spontaneously with a post-void volume less than 50 mL.…”

Pelvic exenteration for recurrent rectal cancer involving the small bowel and abdominal wall – case report

“…Reviewing the latest studies regarding pelvic exenteration for recurrent rectal cancer the mortality varied between 0 and 13% [6][7][8][9][10][11][12][13]. Late oncological results showed a 5-year survival between 14 and 27% [9,12].…”