Pelvic exenteration for locally advanced and recurrent rectal cancer—how much more?

Lau, Yee Chen; Brown, Kilian G. M.; Lee, Peter

doi:10.21037/jgo.2019.01.21

Cited by 24 publications

(18 citation statements)

References 42 publications

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“…Many surgeons will choose to electively employ a prone approach for completion of low en bloc sacrectomy after an initial anterior/abdominal mobilisation phase, but where S1 or S2 are involved, and hence high en bloc sacrectomy is required, then it is an imperative to turn the patient prone after mobilisation from the anterior phase via the abdomen, to complete sacral mobilisation and en bloc tumour resection [ 11 , 13 ] ( Table 1 ).…”

Section: Operative Stepsmentioning

confidence: 99%

“…Sacral division can be performed with a straight osteotome and mallet, a pneumatic drill, a Gigli saw or an ultrasonic aspirator [ 4 , 11 , 13 , 21 , 23 , 24 ]. Advocates of the ultrasonic bone aspirator argue that it is less traumatic with increased precision of dissection and safety in the presence of nearby vessels, ureters, dura and nerve roots [ 24 ].…”

Section: Operative Stepsmentioning

confidence: 99%

“…In APR with flap reconstruction, complications, such as wound dehiscence, flap failure and perineal hernia, may have higher incidence when en bloc sacrectomy is additionally undertaken, with a higher transection level on the sacrum associated with higher perineal complication rates [ 38 , 39 , 40 ]. In fact, higher transections may be associated with higher all-cause morbidity, including physical function, pain, quality of life and bladder function [ 1 , 2 , 3 , 4 ], although other studies dispute this [ 13 , 18 , 41 ].…”

Section: Postoperative Complicationsmentioning

confidence: 99%

See 2 more Smart Citations

Towards Standardisation of Technique for En Bloc Sacrectomy for Locally Advanced and Recurrent Rectal Cancer

Rogers

Jenkins

Malietzis

et al. 2021

JCM

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Treatment strategies for advanced or recurrent rectal cancer have evolved such that the ultimate surgical goal to achieve a cure is complete pathological clearance. To achieve this where the sacrum is involved, en bloc sacrectomy is the current standard of care. Sacral resection is technically challenging and has been described; however, the technique has yet to be streamlined across units. This comprehensive review aims to outline the surgical approach to en bloc sacrectomy for locally advanced or recurrent rectal cancer, with standardisation of the operative steps of the procedure and to discuss options that enhance the technique.

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Section: Operative Stepsmentioning

confidence: 99%

Section: Operative Stepsmentioning

confidence: 99%

Section: Postoperative Complicationsmentioning

confidence: 99%

See 1 more Smart Citation

Towards Standardisation of Technique for En Bloc Sacrectomy for Locally Advanced and Recurrent Rectal Cancer

Rogers

Jenkins

Malietzis

et al. 2021

JCM

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“…Specialist centers with centralized surgical management pathways, preoperative imaging assessment teams, and critical care teams are key to improving patient outcomes. Super-radical surgeries are now being commonly performed in some centers with the necessary capabilities, and these centers are achieving high R0 resection rates and low complication rates (42,44,84,88,89). The "growth" of specialist centers requires the mobilization of multidisciplinary resources, the accumulation of experience, and the exploration of different surgical approaches, which in turn can transform occasional involvement into sustained pathfinding.…”

Section: Specialized Managementmentioning

confidence: 99%

Surgical treatment of locally recurrent rectal cancer: a narrative review

Gao¹,

Gu²

2021

Ann Transl Med

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Objective: To summarize the recent literature on surgical treatment of locally recurrent rectal cancer (LRRC).Background: LRRC is a heterogeneous disease that requires a multidisciplinary treatment approach. The treatment and prognosis depend on the site and type of recurrence. Radical resection remains the primary method for achieving long-term survival and improving symptom control. Preoperative chemoradiotherapy can reduce tumor volume and improve the R0 resection rate. Surgeons must clearly understand pelvic anatomy, develop a detailed preoperative plan, adopt a multidisciplinary approach for the surgical resection of the tumor as well as any invaded soft tissues, vessels, and bones, and ensure proper reconstruction.However, extended radical surgery often leads to a higher risk of postoperative complications and a low quality of life.Methods: We searched English-language articles with keywords "locally recurrent rectal cancer", "surgery" and "multidisciplinary team" in PubMed published between January 2000 to October 2020. Conclusions: LRRC is a complex problem. Long-term survival is not impossible following multidisciplinary treatment in appropriately selected LRRC patients. The management of LRRC relies on a specialist team that determines the biological behavior of the tumor and evaluates treatment options through multidisciplinary discussions, thereby balancing the surgical costs and benefits, alleviating postoperative complications, and improving patients' quality of life.

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“…Based on the considerations of radicalism, it is optimal to extracapsular allocation of the tumor as a single block with the surrounding tissue and organs involved in the process. Only in this way [9][10][11] it is possible to adhere to the principle of ablasticity.…”

Section: загальна та невідкла дна хірургіяmentioning

confidence: 99%

Surgical Treatment of Patients With Extraorganic Tumors of the Pelvic Localization With Invasion of the Iliac Vessels

Kryvorotko¹,

Chykin²,

Tymchenko³

et al. 2021

Khark. Surg. Sch.

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The aim of our study was to determine the indications for expanding the scope of operations in patients with pelvic extraorgan local formations. Materials and methods. The results of surgical treatment of 7 patients with nonorgan tumors of the pelvic localization, who underwent resection on the main vessels in connection with their involvement in the tumor process, are presented. Results and discussion. A total of 7 interventions were performed on the iliac arteries — 2 resections with an end-to-end anastomosis and 5 prostheses (one case — the aorta resection with reconstruction with a bifurcation prosthesis). Patients with pelvic extraorgan tumors are a special cohort of patients, due to the presence of several organs in a narrow space, which inevitably causes them to fit snugly to the tumor. Locally advanced tumor process in extraorganic tumors involving the main vessels of the pelvis and adjacent organs is not a reason to refuse surgery, and despite the complications, repeated recurrences and previous operations, are well tolerated by patients. This is especially important due to the lack of a real alternative to surgical treatment of this group of patients. Conclusions. Surgical intervention in the treatment of pelvic inorganic tumors involving the main vessels is the only radical method of treatment. Invasion of the main arterial and venous vessels is not a contraindication to surgery in patients with pelvic tumors. Combined angioplastic interventions allow to achieve a long without recurrent period even after cytoreductive operations.

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Pelvic exenteration for locally advanced and recurrent rectal cancer—how much more?

Cited by 24 publications

References 42 publications

Towards Standardisation of Technique for En Bloc Sacrectomy for Locally Advanced and Recurrent Rectal Cancer

Towards Standardisation of Technique for En Bloc Sacrectomy for Locally Advanced and Recurrent Rectal Cancer

Surgical treatment of locally recurrent rectal cancer: a narrative review

Surgical Treatment of Patients With Extraorganic Tumors of the Pelvic Localization With Invasion of the Iliac Vessels

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