Extended Radical Resection: The Standard of Care for Patients with Advanced Pelvic Malignancy

Solomon, Michael J.; Brown, Kilian G. M.

doi:10.1245/s10434-019-07817-7

Cited by 10 publications

(9 citation statements)

References 9 publications

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“…Palliative PE was rarely indicated for anal SCC but was considered in highly selected patients with debilitating perianal ulceration or fistulation and in whom all other treatments (including radiotherapy and a diverting intestinal stoma) had failed to control symptoms. 12 Surgery PE was defined as en bloc resection of a minimum of 3 pelvic compartments and/or bone or lateral neurovascular resection, 13 and patients who required salvage APR alone (ie, without adjacent organ, bone, or neurovascular involvement) were not included in this study. Exenterative techniques adopted at the authors' unit have been previously reported, 11 including radical approaches for composite pubic bone, 14 sacral, 15 and lateral compartment excision.…”

Section: Methodsmentioning

confidence: 99%

Pelvic Exenteration for Squamous Cell Carcinoma of the Anus: Oncological, Morbidity, and Quality of Life Outcomes

Brown

Solomon

Steffens

et al. 2023

Diseases of the Colon &Amp; Rectum

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BACKGROUND: Salvage surgery is the only potentially curative treatment option for recurrent squamous cell carcinoma of the anus. Where adjacent pelvic viscera, soft tissues and bone are involved, pelvic exenteration with a wide perineal excision may be required to ensure clear surgical margins and increase the likelihood of long-term survival. OBJECTIVE: To report oncological, morbidity and quality of life outcomes of pelvic exenteration for anal squamous cell carcinoma. DESIGN: Cohort study with retrospective analysis of prospectively collected data. SETTINGS: This study was conducted at a high-volume pelvic exenteration center. PATIENTS: Those who underwent pelvic exenteration for anal squamous cell carcinoma between 1994 and 2022. MAIN OUTCOME MEASURES: Local recurrence-free and overall survival, intraoperative and postoperative complication rates, R0 resection rate and long-term quality of life outcomes. RESULTS: Of 958 patients that underwent pelvic exenteration, 66 (6.9%) had anal squamous cell carcinoma. 32 patients (48.5%) were male and median age was 57 years (range 31-79). 10 patients (15%) had primary anal squamous cell carcinoma, 49 (74%) had a recurrent tumor and 7 (11%) had a re-recurrent tumor. 22 (33%) and 16 patients (24%) had a major complication and unplanned return to the operating theatre, respectively. Of the 62 patients who underwent pelvic exenteration with curative intent, 50 (81%) had R0 resection, the 5-year overall and local recurrence-free survival rates were 41% and 37%, respectively. R0 resection was associated with a higher 5-year overall survival (50% vs. 8%, p < 0.001). The mental health component scores and several individual quality of life domains presented improved trajectories postoperatively (all p values <0.05). LIMITATIONS: The generalizability of the findings outside specialist pelvic exenteration centers may be limited. CONCLUSIONS: Morbidity, long-term survival and quality of life outcomes following PE for anal squamous cell carcinoma are comparable to published outcomes of pelvic exenteration for other tumor types..

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Section: Methodsmentioning

confidence: 99%

Pelvic Exenteration for Squamous Cell Carcinoma of the Anus: Oncological, Morbidity, and Quality of Life Outcomes

Brown

Solomon

Steffens

et al. 2023

Diseases of the Colon &Amp; Rectum

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“…Negative resection margins (R0) are the single most important prognostic factor in predicting long-term survival in patients undergoing pelvic exenteration [ 1 , 5 , 7 , 8 , 13 , 49 , 50 , 51 , 52 , 53 , 54 , 55 ]. The goal of exenterative surgery is to resect all involved organs/structures whilst balancing this radicality with an acceptable risk profile and postoperative quality of life.…”

Section: Contemporary Management Strategiesmentioning

confidence: 99%

Contemporary Management of Locally Advanced and Recurrent Rectal Cancer: Views from the PelvEx Collaborative

Collaborative¹

2022

Cancers

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Pelvic exenteration is a complex operation performed for locally advanced and recurrent pelvic cancers. The goal of surgery is to achieve clear margins, therefore identifying adjacent or involved organs, bone, muscle, nerves and/or vascular structures that may need resection. While these extensive resections are potentially curative, they can be associated with substantial morbidity. Recently, there has been a move to centralize care to specialized units, as this facilitates better multidisciplinary care input. Advancements in pelvic oncology and surgical innovation have redefined the boundaries of pelvic exenterative surgery. Combined with improved neoadjuvant therapies, advances in diagnostics, and better reconstructive techniques have provided quicker recovery and better quality of life outcomes, with improved survival This article provides highlights of the current management of advanced pelvic cancers in terms of surgical strategy and potential future developments.

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“…Rates of major bony (70% vs. 50%; P < 0.01) and nerve (40% vs. 25%; P = 0.03) resections at index exenteration were also higher in patients with EPS. This translated to an increased median (IQR) intensive care unit (ICU) (4 [2][3][4][5][6] vs. 3 [0-5]; P < 0.01) and overall (35 [22-67] vs. 22 ; P < 0.01) length of stay (LOS).…”

Section: Re Sultsmentioning

confidence: 99%

“…These technical refinements, combined with improvements in preoperative imaging, neoadjuvant therapies and perioperative care, have translated to dramatic improvements in survival, morbidity and quality of life outcomes reported in the contemporary literature [2, 3]. As a result, PE is now well established as the standard of care for this group of patients [4] and there is increasing interest in exenterative surgery globally.…”

Section: Introductionmentioning

confidence: 99%

Long‐term surgical complications following pelvic exenteration: Operative management of the empty pelvis syndrome

et al. 2022

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AimPelvic exenteration (PE) has become the standard of care for locally advanced and recurrent rectal cancer. The high short‐term morbidity reported from this procedure is well established; however, longer term complications of such radical surgery and their management have not been fully addressed. This study aimed to investigate the incidence, indications and outcomes of long‐term (more than 90‐day) reoperative surgery in this group of patients, with a focus on the empty pelvis syndrome (EPS).MethodsClinical data were extracted from a prospectively maintained database, with additional data pertaining to indications, operative details and outcomes of reoperative surgery obtained from electronic medical records. Patients were excluded if reoperative surgery was endoscopic or radiologically guided, was for the investigation or treatment of recurrent disease, or was clearly unrelated to previous surgery.ResultsOf 716 patients who underwent PE, 75 (11%) required 101 reoperative abdominal or perineal procedures, 52 (51%) of which were in 40 (6%) patients for complications of EPS. This group were more likely to have undergone a total PE (65% vs. 43%; P < 0.01) with either major bony (70% vs. 50%; P < 0.01) and/or nerve (40% vs. 25%; P = 0.03) resections at index exenteration. The patho‐anatomy, surgical management and outcomes of these patients are described herein, considering separately complications of entero‐cutaneous fistula, entero‐perineal fistula, small bowel obstruction and local management of perineal wound complications.ConclusionSix per cent of PE patients will require re‐intervention for the management of EPS. Reliable strategies for preventing EPS remain elusive; however, surgical management is feasible with acceptable short‐term outcomes with the optimum strategy to be selected on an individual patient basis.

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Extended Radical Resection: The Standard of Care for Patients with Advanced Pelvic Malignancy

Cited by 10 publications

References 9 publications

Pelvic Exenteration for Squamous Cell Carcinoma of the Anus: Oncological, Morbidity, and Quality of Life Outcomes

Pelvic Exenteration for Squamous Cell Carcinoma of the Anus: Oncological, Morbidity, and Quality of Life Outcomes

Contemporary Management of Locally Advanced and Recurrent Rectal Cancer: Views from the PelvEx Collaborative

Long‐term surgical complications following pelvic exenteration: Operative management of the empty pelvis syndrome

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