Abstract
Background
Complete pathological resection of locally advanced or recurrent rectal and anal cancer is regarded as one of the most important determinants of oncological outcome. Disease in the lateral pelvic sidewall has been considered a contraindication for pelvic exenteration surgery owing to the significant likelihood of incomplete resection.
Methods
We describe a novel technique (ELSiE) to resect disease involving the lateral pelvic sidewall. Patient demographics, post-operative histology, length of hospital stay and complications were collected from prospectively maintained electronic patient database.
Results
During 2011–2013, six patients underwent pelvic exenteration surgery with the ELSiE approach. All patients had R0 resection. Three patients required sciatic nerve excision. Four patients developed post-operative complications although no major complications occurred.
Conclusions
Patients with locally advanced and recurrent cancer involving the lateral pelvic sidewall may be rendered suitable for potentially curative radical resection with a modification in the approach to the lateral pelvic sidewall. Our pilot series seems to indicate that our novel technique (ELSiE) is feasible, safe and yields high rates of complete pathological resection.
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References
Austin KK, Solomon MJ (2009) Pelvic exenteration with en bloc iliac vessel resection for lateral pelvic wall involvement. Dis Colon Rectum 52:1223–1233
Ogunbiyi OA, McKenna K, Birnbaum EH, Fleshman JW, Kodner IJ (1997) Aggressive surgical management of recurrent rectal cancer—is it worthwhile? Dis Colon Rectum 40:150–155
Pawlik TM, Skibber JM, Rodriguez-Bigas MA (2006) Pelvic exenteration for advanced pelvic malignancies. Ann Surg Oncol 13:612–623
Boyle KM, Sagar PM, Chalmers AG, Sebag-Montefiore D, Cairns A, Eardley I (2005) Surgery for locally recurrent rectal cancer. Dis Colon Rectum 48:929–937
Dozois EJ, Privitera A, Holubar SD et al (2011) High sacrectomy for locally recurrent rectal cancer: can long-term survival be achieved? J Surg Oncol 103:105–109
Bhangu A, Ali SM, Brown G, Nicholls RJ, Tekkis P (2013) Indications and outcome of pelvic exenteration for locally advanced primary and recurrent rectal cancer. Ann Surg 259:315–322
Nielsen MB, Rasmussen P, Keller J, Laurberg S (2012) Preliminary experience with external hemipelvectomy for locally advanced and recurrent pelvic carcinoma. Colorectal Dis 14:152–156
Apffelstaedt JP, Driscoll DL, Spellman JE, Velez AF, Gibbs JF, Karakousis CP (1996) Complications and outcome of external hemipelvectomy in the management of pelvic tumors. Ann Surg Oncol 3:304–309
Baliski CR, Schachar NS, McKinnon JG, Stuart GC, Temple WJ (2004) Hemipelvectomy: a changing perspective for a rare procedure. Can J Surg 47:99–103
Haddock MG, Miller RC, Nelson H et al (2011) Combined modality therapy including intraoperative electron irradiation for locally recurrent colorectal cancer. Int J Radiat Oncol Biol Phys 79:143–150
Mathis KL, Nelson H, Pemberton JH, Haddock MG, Gunderson LL (2008) Unresectable colorectal cancer can be cured with multimodality therapy. Ann Surg 248:592–598
Yeo HL, Paty PB (2014) Management of recurrent rectal cancer: practical insights in planning and surgical intervention. J Surg Oncol 109:47–52
Clavien PA, Barkun J, de Oliveira ML et al (2009) The Clavien–Dindo classification of surgical complications: five-year experience. Ann Surg 250:187–196
Brunschwig A (1948) Complete excision of pelvic viscera for advanced carcinoma; a one-stage abdominoperineal operation with end colostomy and bilateral ureteral implantation into the colon above the colostomy. Cancer 1:177–183
Lopez-Kostner F, Fazio VW, Vignali A, Rybicki LA, Lavery IC (2001) Locally recurrent rectal cancer: predictors and success of salvage surgery. Dis Colon Rectum 44:173–178
Park JK, Kim YW, Hur H et al (2009) Prognostic factors affecting oncologic outcomes in patients with locally recurrent rectal cancer: impact of patterns of pelvic recurrence on curative resection. Langenbecks Arch Surg 394:71–77
Avradopoulos KA, Vezeridis MP, Wanebo HJ (1996) Pelvic exenteration for recurrent rectal cancer. Adv Surg 29:215–233
Varker KA, Wanebo HJ (2010) Salvage of pelvic recurrence of colorectal cancer. J Surg Oncol 101:649–660
Chew MH, Brown WE, Masya L, Harrison JD, Myers E, Solomon MJ (2013) Clinical, MRI, and PET-CT criteria used by surgeons to determine suitability for pelvic exenteration surgery for recurrent rectal cancers: a Delphi study. Dis Colon Rectum 56:717–725
Garcia-Aguilar J, Cromwell JW, Marra C, Lee SH, Madoff RD, Rothenberger DA (2001) Treatment of locally recurrent rectal cancer. Dis Colon Rectum 44:1743–1748
Melton GB, Paty PB, Boland PJ et al (2006) Sacral resection for recurrent rectal cancer: analysis of morbidity and treatment results. Dis Colon Rectum 49:1099–1107
Wanebo HJ, Koness RJ, Vezeridis MP, Cohen SI, Wrobleski DE (1994) Pelvic resection of recurrent rectal cancer. Ann Surg 220:586–595; discussion 595–597
Yamada K, Ishizawa T, Niwa K, Chuman Y, Akiba S, Aikou T (2001) Patterns of pelvic invasion are prognostic in the treatment of locally recurrent rectal cancer. Br J Surg 88:988–993
Kanemitsu Y, Hirai T, Komori K, Kato T (2010) Prediction of residual disease or distant metastasis after resection of locally recurrent rectal cancer. Dis Colon Rectum 53:779–789
Bernstein TE, Endreseth BH, Romundstad P, Wibe A, Norwegian Colorectal Cancer Group (2009) Circumferential resection margin as a prognostic factor in rectal cancer. Br J Surg 96:1348–1357
Wibe A, Rendedal PR, Svensson E et al (2002) Prognostic significance of the circumferential resection margin following total mesorectal excision for rectal cancer. Br J Surg 89:327–334
Heriot Kumar (2000) Rectal cancer recurrence: factors and mechanisms. Colorectal Dis 2:126–136
Moriya Y (2006) Treatment strategy for locally recurrent rectal cancer. Jpn J Clin Oncol 36:127–131
Wiig JN, Giercksky KE, Tveit KM (2014) Intraoperative radiotherapy for locally advanced or locally recurrent rectal cancer: does it work at all? Acta Oncol 53:865–876
Wiig JN, Poulsen JP, Larsen S, Braendengen M, Waehre H, Giercksky KE (2002) Total pelvic exenteration with preoperative irradiation for advanced primary and recurrent rectal cancer. Eur J Surg 168:42–48
Turley RS, Czito BG, Haney JC, Tyler DS, Mantyh CR, Migaly J (2013) Intraoperative pelvic brachytherapy for treatment of locally advanced or recurrent colorectal cancer. Tech Coloproctol 17:95–100
Hyngstrom JR, Tzeng CW, Beddar S et al (2014) Intraoperative radiation therapy for locally advanced primary and recurrent colorectal cancer: ten-year institutional experience. J Surg Oncol 109:652–658
Hockel M (2008) Laterally extended endopelvic resection (LEER)—principles and practice. Gynecol Oncol 111:S13–S17
Kameyama M, Nakamori S, Imaoka S et al (1993) Composite resection of sciatic nerve for local recurrence of rectal cancer. Gan To Kagaku Ryoho 20:1689–1691
Bickels J, Wittig JC, Kollender Y, Kellar-Graney K, Malawer MM, Meller I (2002) Sciatic nerve resection: is that truly an indication for amputation? Clin Orthop Relat Res 399:201–204
Fuchs B, Davis AM, Wunder JS et al (2001) Sciatic nerve resection in the thigh: a functional evaluation. Clin Orthop Relat Res 382:34–41
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Shaikh, I., Aston, W., Hellawell, G. et al. Extended lateral pelvic sidewall excision (ELSiE): an approach to optimize complete resection rates in locally advanced or recurrent anorectal cancer involving the pelvic sidewall. Tech Coloproctol 18, 1161–1168 (2014). https://doi.org/10.1007/s10151-014-1234-9
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DOI: https://doi.org/10.1007/s10151-014-1234-9