Systematic review of outcomes following pelvic exenteration for the treatment of primary and recurrent locally advanced rectal cancer

Platt, Esther; Dovell, George; Smolarek, Sebastian

doi:10.1007/s10151-018-1883-1

Cited by 65 publications

(64 citation statements)

References 32 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…Despite the now acceptable overall postoperative mortality rates, postoperative complications remain a challenge in this patient group. The incidence of postoperative complications following pelvic exenteration and CRS & HIPEC ranges from 40 to 100% [5][6][7]. Therefore, effective targeted interventions to reduce postoperative complications are needed.…”

Section: Introductionmentioning

confidence: 99%

Feasibility and acceptability of a preoperative exercise program for patients undergoing major cancer surgery: results from a pilot randomized controlled trial

Steffens

Young

Beckenkamp

et al. 2021

Pilot Feasibility Stud

View full text Add to dashboard Cite

Objective To establish the feasibility and acceptability of a preoperative exercise program, and to obtain pilot data on the likely difference in key surgical outcomes to inform the sample size calculation for a full-scale trial. Design Pilot randomized controlled trial. Setting Royal Prince Alfred Hospital, Sydney, Australia. Subjects We included patients undergoing elective pelvic exenteration or cytoreductive surgery aged 18 to 80 years, who presented to the participating gastrointestinal surgeon at least 2 weeks prior to surgery. Patients presenting cognitive impairment, co-morbidity preventing participation in exercise, inadequate English language, currently participating in an exercise program or unable to attend the exercise program sessions were excluded. Methods Participants were randomized to a 2–6 weeks preoperative, face-to-face, individualised exercise program or to usual care. Feasibility was assessed with consent rates to the study, and for the intervention group, retention and adherence rates to the preoperative exercise program. Acceptability of the exercise program was assessed with a semi-structured questionnaire exploring the advice received and the amount, duration and intensity of the exercise program. In addition, postoperative complication rates (Clavien-Dindo), length of hospital stay and self-reported measures of health-related quality of life (SF-36v2) were collected at baseline, day before surgery and in-hospital up to discharge from hospital. Results Of 122 patients screened, 26 (21%) were eligible and 22 (85%) accepted to participate in the trial and were randomized to the intervention (11; 50%) or control group (11; 50%). The median age of the include participants was 63 years. Adherence to the preoperative exercise sessions was 92.7%, with all participants either satisfied (33%) or extremely satisfied (67%) with the overall design of the preoperative exercise program. No significant differences in outcomes were found between groups. Conclusions The results of our pilot trial demonstrate that a preoperative exercise program is feasible and acceptable to patients undergoing major abdominal cancer surgery. There is an urgent need for a definite trial investigating the effectiveness of a preoperative exercise program on postoperative outcomes in patients undergoing major abdominal cancer surgery. This could potentially reduce postoperative complication rates, length of hospital stay and subsequently overall health care costs. Trial registration ACTRN12617001129370. Registered on August 1, 2017, https://www.anzctr.org.au/Trial/Registration/TrialReview.aspx?id=373396&showOriginal=true&isReview=true

show abstract

Section: Introductionmentioning

confidence: 99%

Feasibility and acceptability of a preoperative exercise program for patients undergoing major cancer surgery: results from a pilot randomized controlled trial

Steffens

Young

Beckenkamp

et al. 2021

Pilot Feasibility Stud

View full text Add to dashboard Cite

show abstract

“…Currently, PE continues to be the only curative treatment for advanced or recurrent pelvic cancer. In the early 2000s, the PE-associated mortality rate decreased to approximately 5%, due to improvements in surgical techniques and the postoperative care of these patients [16] and was found to be 0-8.7% in a recent systematic review [17] Several reports on use of laparoscopic surgery for TPE as minimally invasive surgery have been published; however, it remains difficult to manipulate forceps within a narrow pelvis, which tends to prolong the operative time [2,[18][19][20]. Therefore, we evaluated the feasibility of laparoscopicassisted Ta PE in overcoming the current difficulties of PE.…”

Section: Discussionmentioning

confidence: 99%

Feasibility of laparoscopic-assisted transanal pelvic exenteration in locally advanced rectal cancer with anterior invasion

et al. 2020

View full text Add to dashboard Cite

Background Transanal (Ta) pelvic exenteration is a promising, minimally invasive method for treating locally advanced colorectal cancer. However, since it is technically difficult to perform, Ta pelvic exenteration is rarely reported in locally advanced T4 rectal cancer cases. The aim of this study was to evaluate the feasibility of transabdominal laparoscopy-assisted Ta pelvic exenteration. Methods Six patients (4 males and 2 females) had laparoscopy-assisted Ta total or posterior pelvic exenteration for locally advanced or recurrent colorectal cancer cases at the Nagasaki University Hospital between September 2018 and August 2019. Clinical and pathological outcomes were measured and analyzed. Results The median operation time and intraoperative blood loss were 481 (range 456-709) minutes and 352.5 (range 257-1660) ml, respectively. R0 resection was achieved in all cases, and no patient required open surgery. Two patients had grade 3 complications (Clavien-Dindo) or higher. There was no mortality, and no reoperation was required. Conclusions The results suggest that laparoscopic-assisted Ta pelvic exenteration is an acceptable procedure, may help overcome the current technical difficulties, and may improve outcomes in patients with locally advanced rectal cancer.

show abstract

“…However, it was conducted in a referral centre for bTME surgery, and it is the first to assess the rate of readmission in a structured way. It has been suggested that high degree of variability of reporting outcomes exists in patients undergoing surgery for LAPRC and LRRC [5]. Available guidelines on colon and rectal cancer do not specifically recommend collecting this parameter [28, 29].…”

Section: Discussionmentioning

confidence: 99%

“…Available guidelines on colon and rectal cancer do not specifically recommend collecting this parameter [28, 29]. Thirty-day readmission might be an important quality indicator, worth including consistently within a standardization of reporting on the outcomes of bTME among other variables that need to be considered in patients with advanced colorectal cancers [5, 30, 31].…”

Section: Discussionmentioning

confidence: 99%

Predictors of short-term readmission after beyond total mesorectal excision for primary locally advanced and recurrent rectal cancer

et al. 2019

View full text Add to dashboard Cite

Unplanned readmissions heavily affect the cost of health care and are used as an indicator of performance. No clear data are available regarding beyond-total mesorectal excision (bTME) procedure. Aim of the study is to identify patient-related and surgery-related factors influencing the 30-day readmissions after bTME. Retrospective data were collected from 220 patients who underwent bTME procedures at single centre between 2006 and 2016. Patient-related and operative factors were assessed, including body mass index (BMI), age, gender, American Society of Anaesthesiologists’ (ASA) score, preoperative stage, neo-adjuvant therapy, primary tumour vs recurrence, the extent of surgery. The readmission rate was 8.18%. No statistically significant association was found with BMI, ASA score, length of stay and stay in the intensive care unit, primary vs recurrent tumour or blood transfusions. Not quite statistically significant was the association with pelvic side wall dissection (OR 3.32, p = 0.054). Statistically significant factors included preoperative stage > IIIb (OR: 4.77, p = 0.002), neo-adjuvant therapy (OR: 0.13, p = 0.0006), age over 65 years (OR: 5.96, p = 0.0005), any re-intervention during the first admission (OR: 7.4, p = 0.0001), and any post-operative complication (OR: 9.01, p = 0.004). The readmission rate after beyond-TME procedure is influenced by patient-related factors as well as post-operative morbidity. Electronic supplementary material The online version of this article (10.1007/s13304-019-00669-6) contains supplementary material, which is available to authorized users.

show abstract

Systematic review of outcomes following pelvic exenteration for the treatment of primary and recurrent locally advanced rectal cancer

Cited by 65 publications

References 32 publications

Feasibility and acceptability of a preoperative exercise program for patients undergoing major cancer surgery: results from a pilot randomized controlled trial

Feasibility and acceptability of a preoperative exercise program for patients undergoing major cancer surgery: results from a pilot randomized controlled trial

Feasibility of laparoscopic-assisted transanal pelvic exenteration in locally advanced rectal cancer with anterior invasion

Predictors of short-term readmission after beyond total mesorectal excision for primary locally advanced and recurrent rectal cancer

Contact Info

Product

Resources

About