Outcomes of extended radical resections for locally advanced and recurrent pelvic malignancy involving the aortoiliac axis

Abstract

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

“…Historically, the presence of hydronephrosis, gross lower limb oedema, and invasion of the sciatic notch or involvement of the aortoiliac axis suggested inoperable disease. Various studies have demonstrated the safety and efficacy of major extra-anatomic resections involving these structures in selective patients [ 64 , 65 , 66 ]. En bloc sciatic nerve and/or lumbosacral trunk resections for tumours extending laterally into the piriformis muscle have demonstrated similar R0 rates to central pelvic tumours [ 13 ].…”

“…Functional outcomes are always a concern when undertaking these radical resections; however, almost all patients undergoing complete sciatic nerve resection regain mobility post-operatively following intensive physiotherapy and orthotics input [ 64 ]. En bloc major vascular resections of the aortoiliac axis are also shown to be feasible in select patients in specialised centres, with an R0 rate of 81.8% reported in one study [ 65 ].…”

“…The development of regional/national specialized units has allowed funding and structural/service supports to enable these centres to establish specialist pelvic oncology units. As a result, extended bony and/or neurovascular resections are pursued more frequently, with an acceptable morbidity reported [ 18 , 65 , 102 ].…”

“…Improved reconstructive techniques have facilitated these more radical resections [ 21 , 65 , 98 , 99 ]. However, the repair of large bony defects remains a challenge [ 126 ].…”