Preoperative assessment and optimisation for pelvic exenteration in locally advanced and recurrent rectal cancer: A review

Drami, Ioanna; Lord, Amy; Sarmah, Panchali; Baker, R. P.; Daniels, IR; Chappell, K.; Griffiths, Ben; Mohan, Helen; Jenkins, John T.

doi:10.1016/j.ejso.2021.11.007

Cited by 9 publications

(6 citation statements)

References 105 publications

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“…However, the role of MRI of the abdomen/pelvis is well-established [ 24 ]. MRI liver is used to characterise equivocal lesions on CT [ 25 ]. Therefore, the role of WB-MRI may evolve over time as a viable alternative to CT.…”

Section: Contemporary Management Strategiesmentioning

confidence: 99%

“…Perioperative strategies to optimise the outcomes of patients undergoing pelvic exenteration or extended resection for pelvic cancers is critical to maximising treatment success [ 40 ]. Pre-existing co-morbidities are associated with poorer outcomes [ 25 ]. Prehabilitation can be defined as the process of ‘optimising physical functionality preoperatively to enable the individual to maintain a normal level of function during and after surgery’.…”

Section: Contemporary Management Strategiesmentioning

confidence: 99%

“…These defects may range from simple mucosal defects to full circumferential loss due to posterior vaginal wall resection. Anatomy and function can be restored using a rectus abdominis myofascial flap, deep inferior epigastric perforator (DIEP) flap, bilateral gracilis flats or gluteus maximus special flaps [ 25 ].…”

Section: Contemporary Management Strategiesmentioning

confidence: 99%

“…Where possible, the anaesthetist undertaking the case should personally pre-assess the high-risk patient undergoing exenteration; Cancer-related malnutrition occurs secondary to anorexia, nausea, vomiting, metabolic disorders and psychological factors in patients undergoing major oncological surgery. Two cohort studies identified that 32.5% and 24% of their populations, respectively, were malnourished before exenteration when assessed by the subjective global assessment (SGA) tool [25]. The optimisation of nutritional and metabolic state prior to surgery contributes to improved perioperative outcomes and is being increasingly employed as part of preoperative MDT disease management [45].…”

mentioning

confidence: 99%

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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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Section: Contemporary Management Strategiesmentioning

confidence: 99%

Section: Contemporary Management Strategiesmentioning

confidence: 99%

Section: Contemporary Management Strategiesmentioning

confidence: 99%

mentioning

confidence: 99%

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

Collaborative¹

2022

Cancers

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“…2 Centralisation of PES has been shown to improve both perioperative and oncological outcomes, including R0 resection rate. 3,4 While the majority of published data on PES comes from high volume units, there is emerging evidence of acceptable short and long-term outcomes in lower volume units with suitable multidisciplinary expertise. 1,5 A multidisciplinary approach to complex pelvic surgery with dedicated Complex Pelvic Surgery Multi-Disciplinary Team (MDT) was established at Liverpool Hospital in September 2015.…”

Section: Introductionmentioning

confidence: 99%

Pelvic exenteration surgery outcomes following establishment of a Complex Pelvic Surgery multidisciplinary tertiary unit

Mackowski,

Limmer,

Lata

et al. 2023

Preprint

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Background: Pelvic exenteration surgery (PES) is a complex operation associated with significant morbidity. PES requires sub-specialised multidisciplinary input along with expertise in complex pelvic surgery and anatomy. The majority of published data on PES comes from high volume units, however there is emerging evidence of acceptable short and long-term outcomes in lower volume units where dedicated multidisciplinary teams are established. This study reports outcomes of PES in a lower volume centre with a collaborative multidisciplinary surgical approach. Methods: A retrospective review of patients who underwent PES for benign or malignant pathology at Liverpool and Macquarie University Hospitals between September 2015 and June 2022. Descriptive statistics were performed and Kaplan-Meier survival analysis for patients treated for malignancy with curative intent. Results: A total of 67 patients undergoing pelvic exenteration were included (53.8% female; with mean age 59 years). Indications for PES were colorectal cancer (56.7%), gynaecological cancer (22.4%), other malignancy (9.0%) and complex benign pathology (11.9%). Posterior or total pelvic exenteration was performed in 88.1%. Median hospital stay 16 days. Clavien-Dindo grade III or IV complications occurred in 34.3%. There were two post-operative deaths (3.0%; one palliative intent). For patients treated with curative intent (n=51), R0 resection margin was achieved in 92.2%, and R1 margin in 7.8%. Estimated five year disease-free survival was 57.1%, and five year overall survival was 65.5%. Conclusion: Short and long-term outcomes of PES in a low volume unit with appropriate multidisciplinary expertise are comparable to published data on pelvic exenteration from higher volume units.

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Anaesthesia for pelvic exenteration surgery

Watts,

Jackson,

Harris

et al. 2024

BJA Education

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Preoperative assessment and optimisation for pelvic exenteration in locally advanced and recurrent rectal cancer: A review

Cited by 9 publications

References 105 publications

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

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

Pelvic exenteration surgery outcomes following establishment of a Complex Pelvic Surgery multidisciplinary tertiary unit

Anaesthesia for pelvic exenteration surgery

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