Pelvic exenterations for primary rectal cancer : Analysis from a 10-year national prospective database
Pellino, Gianluca (Hospital Universitari i Politècnic La Fe (València))
Biondo, Sebastiano (Institut d'Investigació Biomèdica de Bellvitge)
Codina Cazador, Antonio (Hospital Universitari de Girona Doctor Josep Trueta)
Enríquez-Navascues, José María (Hospital Universitario de Donostia (Sant Sebastià, País Basc))
Espin-Basany, Eloy (Hospital Universitari Vall d'Hebron)
Roig-Vila, José Vicente (Hospital Vithas Valencia 9 de Octubre)
García-Granero, Eduardo (Hospital Universitari i Politècnic La Fe (València))
Universitat Autònoma de Barcelona

Date:	2018
Abstract:	To 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. Few 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. Eight-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. PE 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.
Rights:	Aquest document està subjecte a una llicència d'ús Creative Commons. Es permet la reproducció total o parcial, la distribució, la comunicació pública de l'obra i la creació d'obres derivades, sempre que no sigui amb finalitats comercials, i sempre que es reconegui l'autoria de l'obra original.
Language:	Anglès
Document:	Article ; recerca ; Versió publicada
Subject:	Pelvic exenteration ; Advanced rectal cancer ; Colorectal surgery ; Complication ; Outcome
Published in:	World Journal of Gastroenterology, Vol. 24, Issue 45 (December 2018) , p. 5144-5153, ISSN 2219-2840

DOI: 10.3748/wjg.v24.i45.5144
PMID: 30568391

11 p, 1015.4 KB

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