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

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英文篇名：Pelvic exenterations for primary rectal cancer: Analysis from a 10-year national prospective database 作者：Gianluca ; Pellino ; Eduardo ; García-Granero ; Sebastiano ; Biondo ; Antonio ; Codina ; Cazador ; José ; María ; Enríquez-Navascues ; Eloy ; Espín-Basany ; Jose ; Vicente ; Roig-Vila 英文作者：Gianluca Pellino;Eduardo García-Granero;Sebastiano Biondo;Antonio Codina Cazador;José María Enríquez-Navascues;Eloy Espín-Basany;Jose Vicente Roig-Vila;Colorectal Unit, Hospital Universitario y Politecnico La Fe, University of Valencia;Department of General and Digestive Surgery, Colorectal Unit, Bellvitge University Hospital, University of Barcelona and IDIBELL, L’Hospitalet de Llobregat;Department of General and Digestive Surgery--Colorectal Unit, Josep Trueta University Hospital;General and Digestive Surgery Department, Donostia University Hospital;Department of General Surgery, Colorectal Surgery Unit, Hospital Valle de Hebron, Autonomous University of Barcelona;Unit of Coloproctology, Hospital Vithas-Nisa 9 de Octubre; 英文关键词：Pelvic exenteration;;Advanced rectal cancer;;Colorectal surgery;;Complication;;Outcome 中文刊名：ZXXY 英文刊名：世界胃肠病学杂志(英文版) 机构：Colorectal Unit, Hospital Universitario y Politecnico La Fe, University of Valencia;Department of General and Digestive Surgery, Colorectal Unit, Bellvitge University Hospital, University of Barcelona and IDIBELL, L’Hospitalet de Llobregat;Department of General and Digestive Surgery--Colorectal Unit, Josep Trueta University Hospital;General and Digestive Surgery Department, Donostia University Hospital;Department of General Surgery, Colorectal Surgery Unit, Hospital Valle de Hebron, Autonomous University of Barcelona;Unit of Coloproctology, Hospital Vithas-Nisa 9 de Octubre; 出版日期：2018-12-07 出版单位：World Journal of Gastroenterology 年：2018 期：v.24 语种：英文; 页：ZXXY201845009 页数：10 CN：45 分类号：92-101

摘要

AIM 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.METHODS 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 Espa?ola de Cirujanos(AEC)]. Primary endpoints included procedure-associated complications, 5-year local recurrence(LR), disease-free survival(DFS) and overall survival(OS). A propensitymatched comparison with patients who underwent non-exenterative surgery for low rectal cancers was performed as a secondary endpoint.RESULTS 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.CONCLUSION 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.
        AIM 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.METHODS 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 Espa?ola de Cirujanos(AEC)]. Primary endpoints included procedure-associated complications, 5-year local recurrence(LR), disease-free survival(DFS) and overall survival(OS). A propensitymatched comparison with patients who underwent non-exenterative surgery for low rectal cancers was performed as a secondary endpoint.RESULTS 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.CONCLUSION 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.

引文

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