Factors affecting outcomes following pelvic exenteration for locally recurrent rectal cancer

被引：146

作者：

Kelly, M. E. ^{[1
]}

Glynn, R. ^{[2
]}

Aalbers, A. G. J. ^{[3
,5
]}

Abraham-Nordling, M. ^{[4
]}

Alberda, W.

Antoniou, A. ^{[6
]}

Austin, K. K. ^{[7
]}

Beets, G. L. ^{[3
]}

Beynon, J. ^{[8
]}

Bosman, S. J. ^{[9
]}

Brunner, M. ^{[10
]}

Buchler, M. W. ^{[11
]}

Burger, J. W. A. ^{[5
]}

Campain, N. ^{[12
]}

Christensen, H. K. ^{[13
]}

Codd, M. ^{[2
]}

Coscia, M. ^{[14
]}

Colquhoun, A. J. ^{[15
]}

Daniels, I. R. ^{[12
]}

Davies, R. J. ^{[15
]}

de Wilt, J. H. W. ^{[16
]}

Deutsch, C. ^{[15
]}

Dietz, D. ^{[17
]}

Eglinton, T. ^{[18
]}

Fearnhead, N. ^{[15
]}

Frizelle, F. A. ^{[18
]}

Garcia-Sabrido, J. L. ^{[19
]}

George, M. L. ^{[20
]}

Gentilini, L. ^{[14
]}

Harris, D. A. ^{[8
]}

Harji, D. ^{[21
]}

Heriot, A. G. ^{[22
]}

Brunner, W. Hohenberger ^{[10
]}

Jenkins, J. T. ^{[6
]}

Kanemitsu, Y. ^{[23
]}

Chan, K. K. L. ^{[24
]}

Kim, H. ^{[25
]}

Koh, C. E. ^{[7
]}

Kok, N. F. ^{[3
]}

Kontovounisios, C. ^{[26
]}

Kulu, Y. ^{[27
]}

Law, W. L. ^{[24
]}

Le, G. N. ^{[28
]}

Lee, P. ^{[7
]}

Lydrup, M. L. ^{[29
]}

Lynch, A. C. ^{[22
]}

Martling, A. ^{[30
]}

Meijerink, J. ^{[31
]}

Merkel, S. ^{[10
]}

McDermott, F. D. ^{[12
]}

机构：

[1] St Vincents Univ Hosp, Ctr Colorectal Dis, Dublin, Ireland

[2] Univ Coll Dublin, Ctr Support & Training Anal & Res, Dublin, Ireland

[3] Netherlands Canc Inst, Amsterdam, Netherlands

[4] Karolinska Univ Hosp, Stockholm, Sweden

[5] Erasmus MC, Rotterdam, Netherlands

[6] St Marks Hosp, Harrow, Middx, England

[7] Royal Prince Alfred Hosp, Camperdown, NSW, Australia

[8] Singleton Hosp, Swansea, W Glam, Wales

[9] Catharina Hosp, Eindhoven, Netherlands

[10] Erlangen Hosp, Erlangen, Germany

[11] Heidelberg Univ Hosp, Heidelberg, Germany

[12] Royal Devon & Exeter Hosp, Exeter, Devon, England

[13] Aarhus Univ Hosp, Aarhus, Denmark

[14] St Orsola Malpighi Hosp, Bologna, Italy

[15] Addenbrookes Hosp, Cambridge, England

[16] Radboud Univ Nijmegen, Med Ctr, Nijmegen, Netherlands

[17] Univ Hosp Cleveland, Cleveland, OH 44106 USA

[18] Christchurch Hosp, Christchurch, New Zealand

[19] Gregorio Maranon Gen Univ Hosp, Madrid, Spain

[20] Guys & St Thomas Hosp, London, England

[21] Leeds Gen Infirm, Leeds, W Yorkshire, England

[22] Peter MacCallum Canc Ctr, Melbourne, Vic, Australia

[23] Natl Canc Ctr, Tokyo, Japan

[24] Queen Mary Hosp, Hong Kong, Hong Kong, Peoples R China

[25] Cleveland Clin, Cleveland, OH 44106 USA

[26] Royal Marsden Hosp, London, England

[27] Heidelberg Univ, Heidelberg, Germany

[28] Dublin City Univ, Dublin, Ireland

[29] Skane Univ Hosp, Lund, Sweden

[30] Karolinska Univ Hosp, Stockholm, Sweden

[31] Vrije Univ Amsterdam, Med Ctr, Amsterdam, Netherlands

[32] Erasmus MC Canc Inst, Rotterdam, Netherlands

[33] Gregorio Maranon Gen Univ Hosp, Madrid, Spain

来源：

BRITISH JOURNAL OF SURGERY | 2018年 / 105卷 / 06期

关键词：

QUALITY-OF-LIFE; SURGICAL-MANAGEMENT; COLORECTAL-CANCER; SURGERY; MALIGNANCIES; RADIOTHERAPY; RESECTION; EXCISION; IMPACT; TRIAL;

D O I：

10.1002/bjs.10734

中图分类号：

R61 [外科手术学];

学科分类号：

摘要：

BackgroundPelvic exenteration for locally recurrent rectal cancer (LRRC) is associated with variable outcomes, with the majority of data from single-centre series. This study analysed data from an international collaboration to determine robust parameters that could inform clinical decision-making. MethodsAnonymized data on patients who had pelvic exenteration for LRRC between 2004 and 2014 were accrued from 27 specialist centres. The primary endpoint was survival. The impact of resection margin, bone resection, node status and use of neoadjuvant therapy (before exenteration) was assessed. ResultsOf 1184 patients, 614 (519 per cent) had neoadjuvant therapy. A clear resection margin (R0 resection) was achieved in 554 per cent of operations. Twenty-one patients (18 per cent) died within 30days and 380 (321 per cent) experienced a major complication. Median overall survival was 36months following R0 resection, 27months after R1 resection and 16months following R2 resection (P<0001). Patients who received neoadjuvant therapy had more postoperative complications (unadjusted odds ratio (OR) 153), readmissions (unadjusted OR 233) and radiological reinterventions (unadjusted OR 212). Three-year survival rates were 481 per cent, 339 per cent and 15 per cent respectively. Bone resection (when required) was associated with a longer median survival (36 versus 29months; P<0001). Node-positive patients had a shorter median overall survival than those with node-negative disease (22 versus 29months respectively). Multivariable analysis identified margin status and bone resection as significant determinants of long-term survival. ConclusionNegative margins and bone resection (where needed) were identified as the most important factors influencing overall survival. Neoadjuvant therapy before pelvic exenteration did not affect survival, but was associated with higher rates of readmission, complications and radiological reintervention. Complete resection is key

引用

页码：650 / 657

页数：8

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