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Pelvic exenterations for primary rectal cancer: Analysis from a 10-year national prospective database
AIM: To identify short-term and oncologic outcomes of pelvic exenterations (PE) for locally advanced primary rectal cancer (LAPRC) in patients included in a national prospective database. METHODS: Few studies report on PE in patients with LAPRC. For this study, we included PE for LAPRC performed bet...
Autores principales: | , , , , , , |
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Formato: | Online Artículo Texto |
Lenguaje: | English |
Publicado: |
Baishideng Publishing Group Inc
2018
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Materias: | |
Acceso en línea: | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6288654/ https://www.ncbi.nlm.nih.gov/pubmed/30568391 http://dx.doi.org/10.3748/wjg.v24.i45.5144 |
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author | Pellino, Gianluca Biondo, Sebastiano Codina Cazador, Antonio Enríquez-Navascues, José María Espín-Basany, Eloy Roig-Vila, Jose Vicente García-Granero, Eduardo |
author_facet | Pellino, Gianluca Biondo, Sebastiano Codina Cazador, Antonio Enríquez-Navascues, José María Espín-Basany, Eloy Roig-Vila, Jose Vicente García-Granero, Eduardo |
author_sort | Pellino, Gianluca |
collection | PubMed |
description | AIM: To identify short-term and oncologic outcomes of pelvic exenterations (PE) for locally advanced primary rectal cancer (LAPRC) in patients included in a national prospective database. METHODS: Few studies report on PE in patients with LAPRC. For this study, we included PE for LAPRC performed between 2006 and 2017, as available, from the Rectal Cancer Registry of the Spanish Association of Surgeons [Asociación Española de Cirujanos (AEC)]. Primary endpoints included procedure-associated complications, 5-year local recurrence (LR), disease-free survival (DFS) and overall survival (OS). A propensity-matched comparison with patients who underwent non-exenterative surgery for low rectal cancers was performed as a secondary endpoint. RESULTS: Eight-two patients were included. The mean age was 61.8 ± 11.5 years. More than half of the patients experienced at least one complication. Surgical site infections were the most common complication (abdominal wound 18.3%, perineal closure 19.4%). Thirty-three multivisceral resections were performed, including two hepatectomies and four metastasectomies. The long-term outcomes of the 64 patients operated on before 2013 were assessed. The five-year LR was 15.6%, the distant recurrence rate was 21.9%, and OS was 67.2%, with a mean survival of 43.8 mo. R+ve resection increased LR [hazard ratio (HR) = 5.58, 95%CI: 1.04-30.07, P = 0.04]. The quality of the mesorectum was associated with DFS. Perioperative complications were independent predictors of shorter survival (HR = 3.53, 95%CI: 1.12-10.94, P = 0.03). In the propensity-matched analysis, PE was associated with better quality of the specimen and tended to achieve lower LR with similar OS. CONCLUSION: PE is an extensive procedure, justified if disease-free margins can be obtained. Further studies should define indications, accreditation policy, and quality of life in LAPRC. |
format | Online Article Text |
id | pubmed-6288654 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2018 |
publisher | Baishideng Publishing Group Inc |
record_format | MEDLINE/PubMed |
spelling | pubmed-62886542018-12-19 Pelvic exenterations for primary rectal cancer: Analysis from a 10-year national prospective database Pellino, Gianluca Biondo, Sebastiano Codina Cazador, Antonio Enríquez-Navascues, José María Espín-Basany, Eloy Roig-Vila, Jose Vicente García-Granero, Eduardo World J Gastroenterol Retrospective Cohort Study AIM: To identify short-term and oncologic outcomes of pelvic exenterations (PE) for locally advanced primary rectal cancer (LAPRC) in patients included in a national prospective database. METHODS: Few studies report on PE in patients with LAPRC. For this study, we included PE for LAPRC performed between 2006 and 2017, as available, from the Rectal Cancer Registry of the Spanish Association of Surgeons [Asociación Española de Cirujanos (AEC)]. Primary endpoints included procedure-associated complications, 5-year local recurrence (LR), disease-free survival (DFS) and overall survival (OS). A propensity-matched comparison with patients who underwent non-exenterative surgery for low rectal cancers was performed as a secondary endpoint. RESULTS: Eight-two patients were included. The mean age was 61.8 ± 11.5 years. More than half of the patients experienced at least one complication. Surgical site infections were the most common complication (abdominal wound 18.3%, perineal closure 19.4%). Thirty-three multivisceral resections were performed, including two hepatectomies and four metastasectomies. The long-term outcomes of the 64 patients operated on before 2013 were assessed. The five-year LR was 15.6%, the distant recurrence rate was 21.9%, and OS was 67.2%, with a mean survival of 43.8 mo. R+ve resection increased LR [hazard ratio (HR) = 5.58, 95%CI: 1.04-30.07, P = 0.04]. The quality of the mesorectum was associated with DFS. Perioperative complications were independent predictors of shorter survival (HR = 3.53, 95%CI: 1.12-10.94, P = 0.03). In the propensity-matched analysis, PE was associated with better quality of the specimen and tended to achieve lower LR with similar OS. CONCLUSION: PE is an extensive procedure, justified if disease-free margins can be obtained. Further studies should define indications, accreditation policy, and quality of life in LAPRC. Baishideng Publishing Group Inc 2018-12-07 2018-12-07 /pmc/articles/PMC6288654/ /pubmed/30568391 http://dx.doi.org/10.3748/wjg.v24.i45.5144 Text en ©The Author(s) 2018. Published by Baishideng Publishing Group Inc. All rights reserved. http://creativecommons.org/licenses/by-nc/4.0/ This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. |
spellingShingle | Retrospective Cohort Study Pellino, Gianluca Biondo, Sebastiano Codina Cazador, Antonio Enríquez-Navascues, José María Espín-Basany, Eloy Roig-Vila, Jose Vicente García-Granero, Eduardo Pelvic exenterations for primary rectal cancer: Analysis from a 10-year national prospective database |
title | Pelvic exenterations for primary rectal cancer: Analysis from a 10-year national prospective database |
title_full | Pelvic exenterations for primary rectal cancer: Analysis from a 10-year national prospective database |
title_fullStr | Pelvic exenterations for primary rectal cancer: Analysis from a 10-year national prospective database |
title_full_unstemmed | Pelvic exenterations for primary rectal cancer: Analysis from a 10-year national prospective database |
title_short | Pelvic exenterations for primary rectal cancer: Analysis from a 10-year national prospective database |
title_sort | pelvic exenterations for primary rectal cancer: analysis from a 10-year national prospective database |
topic | Retrospective Cohort Study |
url | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6288654/ https://www.ncbi.nlm.nih.gov/pubmed/30568391 http://dx.doi.org/10.3748/wjg.v24.i45.5144 |
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