Factors affecting outcomes following pelvic exenteration for locally recurrent rectal cancer

• DOI: 10.1002/bjs.10734
• Publication Date: 2018-03-12T16:46:39Z
• Authors: M E Kelly; R Glynn; A G J Aalbers; M Abraham-Nordling; W Alberda; A Antoniou; K K Austin; G L Beets; J Beynon; S J Bosman; M Brunner; M W Buchler; J W A Burger; N Campain; H K Christensen; M Codd; M Coscia; A J Colquhoun; I R Daniels; R J Davies; J H W de Wilt; C Deutsch; D Dietz; T Eglinton; N Fearnhead; F A Frizelle; J L Garcia-Sabrido; M L George; L Gentilini; D A Harris; D Harji; A G Heriot; W Hohenberger Bru...; J T Jenkins; Y Kanemitsu; K K L Chan; H Kim; C E Koh; N F Kok; C Kontovounisios; Y Kulu; W L Law; G N Lê; P Lee; M L Lydrup; A C Lynch; A Martling; J Meijerink; S Merkel; F D McDermott; J S McGrath; M B Nielsen Chris...; G A P Nieuwenhuijzen; M A Nordling; J M A Northover; P R O'Connell; D Patsouras; G Poggioli; R W Radwan; S Rasheed; P C Rasmussen; J Rothbarth; H J T Rutten; P M Sagar; A M P Schizas; D Shida; N J Smart; M J Solomon; L Stocchi; P P Tekkis; S Tsukamoto; W H Turner; J Tuynman; A Ulrich; A van Leeuwenhoek; G H van Ramshorst; W Vasquez-Jimenez; C Verhoef; M Versteegen; C Wakeman; S Warrier; J Yip; D C Winter
• Keywords: Pelvic exenteration; Neoadjuvant Therapy; Resection margin

Abstract Background Pelvic exenteration for locally recurrent rectal cancer (LRRC) is associated with variable outcomes, the majority of data from single-centre series. This study analysed an international collaboration to determine robust parameters that could inform clinical decision-making. Methods Anonymized on patients who had pelvic LRRC between 2004 and 2014 were accrued 27 specialist centres. The primary endpoint was survival. impact resection margin, bone resection, node status use neoadjuvant therapy (before exenteration) assessed. Results Of 1184 patients, 614 (51·9 per cent) therapy. A clear margin (R0 resection) achieved in 55·4 cent operations. Twenty-one (1·8 died within 30 days 380 (32·1 experienced a major complication. Median overall survival 36 months following R0 after R1 16 R2 (P < 0·001). Patients received more postoperative complications (unadjusted odds ratio (OR) 1·53), readmissions OR 2·33) radiological reinterventions 2·12). Three-year rates 48·1 cent, 33·9 15 respectively. Bone (when required) longer median (36 versus 29 months; P Node-positive shorter than those node-negative disease (22 respectively). Multivariable analysis identified as significant determinants long-term Conclusion Negative margins (where needed) most important factors influencing Neoadjuvant before did not affect survival, but higher readmission, reintervention.