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

World Journal of Gastroenterology 2018年第45期24卷 5144-5153页

作者： Gianluca Pellino Sebastiano Biondo Antonio Codina Cazador JoséMaría Enríquez-Navascues Eloy espín-Basany Jose Vicente Roig-Vila Eduardo García-Granero Colorectal Unit Hospital Universitario y Politecnico La FeUniversity of ValenciaValencia 46026Spain Department of General and Digestive Surgery Colorectal UnitBellvitge University HospitalUniversity of Barcelona and IDIBELLL’Hospitalet de LlobregatBarcelona 08907Spain Department of General and Digestive Surgery--Colorectal Unit Josep Trueta University HospitalGirona 17001Spain General and Digestive Surgery Department Donostia University HospitalDonostia 20014Spain Department of General Surgery Colorectal Surgery UnitHospital Valle de HebronAutonomous University of BarcelonaBarcelona 08035Spain Unit of Coloproctology Hospital Vithas-Nisa 9 de OctubreValencia 46015Spain

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 *** 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 *** 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 *** 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.

关键词： Pelvic exenteration Advanced rectal cancer Colorectal surgery Complication Outcome

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