Posterior pelvic exenteration for primary rectal cancer

Abstract

In the present series, PPE prolonged operative time, increased postoperative complications and showed a trend toward poor prognosis in recurrence and survival. However, PPE offers the only hope for cure to patients with a primary rectal cancer that is adherent or invades reproductive organs.

Pelvic Exenteration for Rectal Cancer

“…39,41 the 5-year local control rate for PaRC ranged from 64.9% to 89% in 3 studies. 42,43,49 Survival the 5-year survival for patients with PaRC was reported in 17 studies and ranged from 31% to 77% (median, 52%), [28][29][30][31][32][33][34]36,38,[40][41][42][43][45][46][47]49 and the median survival for patients with PaRC ranged from 14 to 93 months (median, 35.5 months) as reported in 10 studies. [28][29][30][31][32][33]36,38,[41][42][43][45][46][47]49 the 5-year survival for patients with lRRC ranged from 0% to 37% (median, 18%) as reported in 13 studies, 28,30,32,[34][35][36][41][42][43][44]46,47,49 and the median survival ...…”

“…36,37,39,43,44,50 the age of the patients ranged from 52 to 64 years (median, 59 years) as described in 12 articles. 29,31,[34][35][36]38,41,42,44,45,47,49,50 there were 629 PaRCs with 6 articles describing pelvic exenteration for PaRC only, 29,33,37,39,40,45,50 and 420 lRRCs, with 3 articles describing pelvic exenteration for lRRC only, 35,38,44 and the rest studying pelvic exenteration for both PaRC and lRRC. 28,[30][31][32]34,36,[41][42][43][46][47][48][49][50] Patients underwent total pelvic exenteration, total pelvic exenteration with sacrectomy, anterior pelvic exenteration, posterior pelvic exenteration, and supralevator exenteration.…”

“…28,30,32,35,36,38,[41][42][43][44][45][46][47]49 four studies reported the overall median survival of patients with both lRRC and PaRC who underwent pelvic exenteration to range from 21.4 to 49 months (median, 30.5 months), 34,46,47,50 and the overall 5-year survival for patients who underwent pelvic exenteration for both PaRC and lRRC was reported in 11 studies and ranged from 21.7% to 54.2% (median, 38%). [28][29][30][31][32][33][34][35][36][37][38][39][40][41][42][44][45][46][47][48][49][50] …”

“…28,30,32,33,37,42,44,45,49,50 seven studies described the use of neoadjuvant chemoradiation in 204 patients (median, 69%, ranging from 9% to 85%). 40,41,43,45,[47][48][49] Postoperative chemotherapy was given to 112 patients in 5 studies (median, 56%, ranging from 27% to 79%), 31,34,45,48,50 and postoperative radiation given to 49 patients in 4 studies (median, 24%, ranging from 4% to 85%). 32,34,45,48 ten studies used intraoperative radiation to the pelvic tumor bed when the margins were suspicious or microscopically positive for disease in 157 patients (median, 33.5%, ranging from 2% to 49%), 30,34,35,38,[41][42][43]45,49,50 but 2 studies used intraoperative continuous hyperthermic peritoneal perfusion of the pelvis.…”

“…[28][29][30][31][32][33][34][35][36][37][38][40][41][42][43]45,[47][48][49][50] the perioperative mortality rate ranged from 0% to 25% (median, 2.2%) in 19 studies, [28][29][30][31][32][33][34][35][36][37][38][40][41][42][45][46][47][48][49][50] and 0% to 12% (median, 0.55%) of patients died after 30 days of pelvic exenteration but during the initial hospital admission. 33,34,37,[40][41][42][45][46][47]49 Local Recurrence Resection margins were negative (R0) for 539 patients in 15 studies (median, 7...…”