Pelvic exenterations for primary rectal cancer: Analysis from a 10-year national prospective database

• Published in: World journal of gastroenterology : WJG Vol. 24; no. 45; pp. 5144 - 5153
• Main Authors: Pellino, Gianluca, Biondo, Sebastiano, Codina Cazador, Antonio, Enríquez-Navascues, José María, Espín-Basany, Eloy, Roig-Vila, Jose Vicente, García-Granero, Eduardo
• Format: Journal Article
• Language: English
• Published: United States Baishideng Publishing Group Inc 07-12-2018
• Subjects: Aged; Disease-Free Survival; Female; Humans; Male; Middle Aged; Neoplasm Recurrence, Local - epidemiology; Neoplasm Recurrence, Local - pathology; Neoplasm Recurrence, Local - prevention & control; Neoplasm Staging; Pelvic Exenteration - adverse effects; Perioperative Period; Postoperative Complications - epidemiology; Postoperative Complications - etiology; Prospective Studies; Quality of Life; Rectal Neoplasms - mortality; Rectal Neoplasms - pathology; Rectal Neoplasms - surgery; Rectum - pathology; Retrospective Cohort Study; Retrospective Studies; Risk Assessment; Treatment Outcome; Complication; Pelvic exenteration; Colorectal surgery; Outcome; Advanced rectal cancer
• ISSN: 1007-9327; 2219-2840
• DOI: 10.3748/wjg.v24.i45.5144

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.
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.
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,
= 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,
= 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.
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.