2 research outputs found
Contemporary Management of Locally Advanced and Recurrent Rectal Cancer: Views from the PelvEx Collaborative
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 multi-disciplinary 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
Pelvic Exenteration for Advanced Nonrectal Pelvic Malignancy
Objective: To determine factors associated with outcomes following pelvic
exenteration for advanced nonrectal pelvic malignancy.
Background: The PelvEx Collaborative provides large volume data from
specialist centers to ascertain factors associated with improved outcomes.
Methods: Consecutive patients who underwent pelvic exenteration for nonrectal
pelvic malignancy between 2006 and 2017 were identified from 22
tertiary centers. Patient demographics, neoadjuvant therapy, histopathological
assessment, length of stay, 30-day major complication/mortality rate were
recorded.
The primary endpoints were factors associated with survival. The secondary
endpoints included the difference in margin rates across the cohorts, impact of
neoadjuvant treatment on survival, associated morbidity, and mortality.
Results: One thousand two hundred ninety-three patients were identified.
40.4% (n ¼ 523) had gynecological malignancies (endometrial, ovarian,
cervical, and vaginal), 35.7% (n ¼ 462) urological (bladder), 18.1% (n ¼ 234)
anal, and 5.7% had sarcoma (n ¼ 74).
The median age across the cohort was 63 years (range, 23–85). The median
30-day mortality rate was 1.7%, with the highest rates occurring following
exenteration for recurrent sarcoma or locally advanced cervical cancer (3.3%
each). The median length of hospital stay was 17.5 days. 34.5% of patients
experienced a major complication, with highest rate occurring in those having
salvage surgery for anal cancer.
Multivariable analysis showed R0 resection was the main factor associated
with long-term survival. The 3-year overall-survival rate for R0 resection was
48% for endometrial malignancy, 40.6% for ovarian, 49.4% for cervical,
43.8% for vaginal, 59% for bladder, 48.3% for anal, and 48.1% for sarcoma.
Conclusion: Pelvic exenteration remains an important treatment in selected
patients with advanced or recurrent nonrectal pelvic malignancy. The range in
3-year overall survival following R0 resection (40%–59%) reflects the
diversity of tumor types