Extended lateral pelvic sidewall excision (ELSiE): an approach to optimize complete resection rates in locally advanced or recurrent anorectal cancer involving the pelvic sidewall

Shaikh, I.; Aston, William; Hellawell, Giles; Ross, David A.; Littler, S.; Burling, David; Marshall, MJ; Northover, J. M. A.; Antoniou, Anthony; Jenkins, John T.

doi:10.1007/s10151-014-1234-9

Cited by 52 publications

(27 citation statements)

References 33 publications

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“…An alternative approach has been recently described by the St Mark’s group[69]. It involves an initial transgluteal approach to the sciatic notch which is performed with patient in prone position.…”

Section: Surgical Approach Based On Location Of Diseasementioning

confidence: 99%

Advances in surgical management for locally recurrent rectal cancer: How far have we come?

Lee

Sagar

Sadadcharam

et al. 2017

WJG

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Locally recurrent rectal cancer (LRRC) is a complex disease with far-reaching implications for the patient. Until recently, research was limited regarding surgical techniques that can increase the ability to perform an en bloc resection with negative margins. This has changed in recent years and therefore outcomes for these patients have improved. Novel radical techniques and adjuncts allow for more radical resections thereby improving the chance of negative resection margins and outcomes. In the past contraindications to surgery included anterior involvement of the pubic bone, sacral invasions above the level of S2/S3 and lateral pelvic wall involvement. However, current data suggests that previously unresectable cases may now be feasible with novel techniques, surgical approaches and reconstructive surgery. The publications to date have only reported small patient pools with the research conducted by highly specialised units. Moreover, the short and long-term oncological outcomes are currently under review. Therefore although surgical options for LRRC have expanded significantly, one should balance the treatment choices available against the morbidity associated with the procedure and select the right patient for it.

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Section: Surgical Approach Based On Location Of Diseasementioning

confidence: 99%

Advances in surgical management for locally recurrent rectal cancer: How far have we come?

Lee

Sagar

Sadadcharam

et al. 2017

WJG

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“…The St. Marks group has described their extended lateral pelvic sidewall excision experience of six R0 resections for sidewall recurrences. 29 The authors describe two phases of dissection: the extrapelvic phase and the abdominal phase. The patient is initially placed prone, and dissection is continued down to the gluteal muscles.…”

Section: Pelvic Sidewall Recurrencesmentioning

confidence: 99%

“…The level of vascular division is dependent on whether or not the superior gluteal artery is sacrificed. 29…”

Section: Pelvic Sidewall Recurrencesmentioning

confidence: 99%

Surgery for Locally Recurrent Rectal Cancer: Tips, Tricks, and Pitfalls

Warrier

Heriot

Lynch

2016

Clinics in Colon and Rectal Surgery

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Rectal cancer can recur locally in up to 10% of the patients who undergo definitive resection for their primary cancer. Surgical salvage is considered appropriate in the curative setting as well as select cases with palliative intent. Disease-free survival following salvage resection is dependent upon achieving an R0 resection margin. A clear understanding of applied surgical anatomy, appropriate preoperative planning, and a multidisciplinary approach to aggressive soft tissue, bony, and vascular resection with appropriate reconstruction is necessary. Technical tips, tricks, and pitfalls that may assist in managing these cancers are discussed and the roles of additional boost radiation and intraoperative radiation therapy in the management of such cancers are also discussed.

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“…Shaikh et al recently reported a case series of six highly selected patients undergoing a novel extended lateral pelvic sidewall excision procedure for either primary or recurrent rectal or anal cancer, each achieving an R0 resection. 63 , 64 This standardized technique comprises an extra-pelvic phase and an abdominal phase that converge on the sciatic notch from either side, allowing en bloc resection of tumor. Half of the patients required excision of the sciatic nerve due to tumor involvement, and all patients had the internal iliac vessels ligated either above or below the level of the superior gluteal artery.…”

Section: Introductionmentioning

confidence: 99%

Locally advanced rectal cancer: management challenges

Kokelaar¹,

Evans²,

Davies³

et al. 2016

OTT

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Between 5% and 10% of patients with rectal cancer present with locally advanced rectal cancer (LARC), and 10% of rectal cancers recur after surgery, of which half are limited to locoregional disease only (locally recurrent rectal cancer). Exenterative surgery offers the best long-term outcomes for patients with LARC and locally recurrent rectal cancer so long as a complete (R0) resection is achieved. Accurate preoperative multimodal staging is crucial in assessing the potential operability of advanced rectal tumors, and resectability may be enhanced with neoadjuvant therapies. Unfortunately, surgical options are limited when the tumor involves the lateral pelvic sidewall or high sacrum due to the technical challenges of achieving histological clearance, and must be balanced against the high morbidity associated with resection of the bony pelvis and significant lymphovascular structures. This group of patients is usually treated palliatively and subsequently survival is poor, which has led surgeons to seek innovative new solutions, as well as revisit previously discarded radical approaches. A small number of centers are pioneering new techniques for resection of beyond-total mesorectal excision tumors, including en bloc resections of the sciatic notch and composite resections of the first two sacral vertebrae. Despite limited experience, these new techniques offer the potential for radical treatment of previously inoperable tumors. This narrative review sets out the challenges facing the management of LARCs and discusses evolving management options.

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Extended lateral pelvic sidewall excision (ELSiE): an approach to optimize complete resection rates in locally advanced or recurrent anorectal cancer involving the pelvic sidewall

Cited by 52 publications

References 33 publications

Advances in surgical management for locally recurrent rectal cancer: How far have we come?

Advances in surgical management for locally recurrent rectal cancer: How far have we come?

Surgery for Locally Recurrent Rectal Cancer: Tips, Tricks, and Pitfalls

Locally advanced rectal cancer: management challenges

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