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Pelvic Exenteration Affords Safe and Durable Treatment for Locally Advanced Rectal Carcinoma

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Abstract

Background

Treatment of locally advanced rectal carcinoma (LARC) often involves exenterative surgery, which can be associated with high perioperative morbidity and mortality. To assist in patient selection for radical surgery, we sought to determine clinicopathologic factors influencing recurrence and disease-free survival (DFS) of LARC.

Methods

Consecutive patients with LARC undergoing exenterative surgery were retrospectively identified in our institutional database. Factors evaluated included age, sex, primary versus recurrent tumors, neoadjuvant or adjuvant chemoradiotherapy, resection margin status, recurrence, time to recurrence, and survival. The primary outcome was DFS. Secondary outcomes were overall survival and perioperative morbidity.

Results

A total of 72 patients were identified; median age was 52 years, and median follow-up time was 30 months. The overall complication rate was 43%; rates were similar among the patients with primary (47%) or recurrent (37%) LARC. Primary or recurrent tumor status was the only factor significantly predictive of outcome after exenteration. Local recurrence rates were lower in the primary group (primary 22%, recurrent 52%, P = .05). A significant difference in 5-year DFS was found between primary and recurrent tumor (52% vs. 13%; P < .01). The median time to recurrence was longer in the patients with primary LARC (17 months vs. 8 months; P < .01).

Conclusions

The complication rates for pelvic exenteration remain high, but the morbidity can typically be managed without a clinically important increase in hospitalization. In primary LARC, an aggressive surgical approach provides most patients 5-year DFS. Select patients with recurrent LARC will also benefit from pelvic exenteration.

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References

  1. Jemal A, Murray T, Ward E, et al. Cancer statistics 2005. CA Cancer J Clin 2005;55:10–30

    Article  PubMed  Google Scholar 

  2. Ryan DP, Niedzwiecki D, Hollis D, et al. Phase I/II study of preoperative oxaliplatin, fluorouracil, and external-beam radiation therapy in patients with locally advanced rectal cancer: Cancer and Leukemia Group B 89901. J Clin Oncol 2006;24:2557–62

    Article  PubMed  CAS  Google Scholar 

  3. Wiig JN, Larsen SG, Dueland S, Giercksky KE. Clinical outcome in patients with complete pathologic response (pT0) to preoperative irradiation/chemo-irradiation operated for locally advanced or locally recurrent rectal cancer. J Surg Oncol 2005;92:70–5

    Article  PubMed  Google Scholar 

  4. Chessin DB, Enker W, Cohen AM, et al. Complications after preoperative combined modality therapy and radical resection of locally advanced rectal cancer: a 14-year experience from a specialty service. J Am Coll Surg 2005;200:876–82

    Article  PubMed  Google Scholar 

  5. Greene F, ed. AJCC Cancer Staging Handbook. 6th ed. Vol 1. New York: Springer, 2002:127–38

    Google Scholar 

  6. O’Connell JB, Maggard MA, Liu JH, Etzioni DA, Ko CY. Are survival rates different for young and older patients with rectal cancer? Dis Colon Rectum 2004;47:2064–9

    Article  PubMed  Google Scholar 

  7. Ike H, Shimada H, Ohki S, Yamaguchi S, Ichikawa Y, Fujii S. Outcome of total pelvic exenteration for locally recurrent rectal cancer. Hepatogastroenterology 2003;50:700–3

    PubMed  Google Scholar 

  8. Verschueren RC, Mulder NH, Hooykaas JA, Szabo BG, Karrenbeld A. Pelvic exenteration for advanced primary rectal cancer in male patients. Clin Oncol (R Coll Radiol) 1998;10:318–21

    CAS  Google Scholar 

  9. Esnaola NF, Cantor SB, Johnson ML, et al. Pain and quality of life after treatment in patients with locally recurrent rectal cancer. J Clin Oncol 2002;20:4361–7

    Article  PubMed  Google Scholar 

  10. Martling A, Singnomklao T, Holm T, Rutqvist LE, Cedermark B. Prognostic significance of both surgical and pathological assessment of curative resection for rectal cancer. Br J Surg 2004;91:1040–5

    Article  PubMed  CAS  Google Scholar 

  11. Gerard JP, Romestaing P, Chapet O. Radiotherapy alone in the curative treatment of rectal carcinoma. Lancet Oncol 2003;4:158–66

    Article  PubMed  Google Scholar 

  12. Miller AR, Cantor SB, Peoples GE, Pearlstone DB, Skibber JM. Quality of life and cost effectiveness analysis of therapy for locally recurrent rectal cancer. Dis Colon Rectum 2000;43:1695–701

    Article  PubMed  CAS  Google Scholar 

  13. Sauer R, Becker H, Hohenberger W, et al. Preoperative versus postoperative chemoradiotherapy for rectal cancer. N Engl J Med 2004;351:1731–40

    Article  PubMed  CAS  Google Scholar 

  14. Bedrosian I, Rodriguez-Bigas MA, Feig B, et al. Predicting the node-negative mesorectum after preoperative chemoradiation for locally advanced rectal carcinoma. J Gastrointest Surg 2004;8:56–62

    Article  PubMed  Google Scholar 

  15. Stipa F, Zernecke A, Moore HG, et al. Residual mesorectal lymph node involvement following neoadjuvant combined-modality therapy: rationale for radical resection? Ann Surg Oncol 2004;11:187–91

    Article  PubMed  Google Scholar 

  16. Boyle KM, Sagar PM, Chalmers AG, Sebag-Montefiore D, Cairns A, Eardley I. Surgery for locally recurrent rectal cancer. Dis Colon Rectum 2005;48:929–37

    Article  PubMed  Google Scholar 

  17. Hafner GH, Herrera L, Petrelli NJ. Morbidity and mortality after pelvic exenteration for colorectal adenocarcinoma. Ann Surg 1992;215:63–7

    Article  PubMed  CAS  Google Scholar 

  18. Ike H, Shimada H, Yamaguchi S, Ichikawa Y, Fujii S, Ohki S. Outcome of total pelvic exenteration for primary rectal cancer. Dis Colon Rectum 2003;46:474–80

    Article  PubMed  Google Scholar 

  19. Kakuda JT, Lamont JP, Chu DZ, Paz IB. The role of pelvic exenteration in the management of recurrent rectal cancer. Am J Surg 2003;186:660–4

    Article  PubMed  Google Scholar 

  20. Lopez MJ, Monafo WW. Role of extended resection in the initial treatment of locally advanced colorectal carcinoma. Surgery 1993;113:365–72

    PubMed  CAS  Google Scholar 

  21. Hafner GH, Herrera L, Petrelli NJ. Patterns of recurrence after pelvic exenteration for colorectal adenocarcinoma. Arch Surg 1991;126:1510–3

    PubMed  CAS  Google Scholar 

  22. Salo JC, Paty PB, Guillem J, Minsky BD, Harrison LB, Cohen AM. Surgical salvage of recurrent rectal carcinoma after curative resection: a 10-year experience. Ann Surg Oncol 1999;6:171–7

    Article  PubMed  CAS  Google Scholar 

  23. Harisinghani MG, Gervais DA, Maher MM, et al. Transgluteal approach for percutaneous drainage of deep pelvic abscesses: 154 cases. Radiology 2003;228:701–5

    Article  PubMed  Google Scholar 

  24. Heller L, Levin SL, Butler CE. Management of abdominal wound dehiscence using vacuum assisted closure in patients with compromised healing. Am J Surg 2006;191:165–72

    Article  PubMed  Google Scholar 

  25. Kato T, Yamagami T, Iida S, Tanaka O, Hirota T, Nishimura T. Percutaneous drainage under real-time computed tomography-fluoroscopy guidance. Hepatogastroenterology 2005;52:1048–52

    PubMed  Google Scholar 

  26. Erdmann D, Drye C, Heller L, Wong MS, Levin SL. Abdominal wall defect and enterocutaneous fistula treatment with the Vacuum-Assisted Closure (VAC) system. Plast Reconstr Surg 2001;108:2066–8

    Article  PubMed  CAS  Google Scholar 

  27. Yamada K, Ishizawa T, Niwa K, Chuman Y, Aikou T. Pelvic exenteration and sacral resection for locally advanced primary and recurrent rectal cancer. Dis Colon Rectum 2002;45:1078–84

    Article  PubMed  Google Scholar 

  28. Jimenez RE, Shoup M, Cohen AM, Paty PB, Guillem J, Wong WD. Contemporary outcomes of total pelvic exenteration in the treatment of colorectal cancer. Dis Colon Rectum 2003;46:1619–25

    PubMed  Google Scholar 

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Authors and Affiliations

  1. Department of Surgical Oncology, Unit 444, The University of Texas M. D. Anderson Cancer Center, 1515 Holcombe Boulevard, Houston, Texas, 77030, USA

    Christopher J. Gannon MD, Jonathan S. Zager MD, George J. Chang MD, Barry W. Feig MD, John M. Skibber MD & Miguel A. Rodriguez-Bigas MD

  2. Department of Urology, Unit 1373, The University of Texas M. D. Anderson Cancer Center, 1515 Holcombe Boulevard, Houston, Texas, 77030, USA

    Christopher G. Wood MD

Authors
  1. Christopher J. Gannon MD
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  2. Jonathan S. Zager MD
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  3. George J. Chang MD
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  4. Barry W. Feig MD
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  5. Christopher G. Wood MD
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  6. John M. Skibber MD
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  7. Miguel A. Rodriguez-Bigas MD
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Corresponding author

Correspondence to Miguel A. Rodriguez-Bigas MD.

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Gannon, C.J., Zager, J.S., Chang, G.J. et al. Pelvic Exenteration Affords Safe and Durable Treatment for Locally Advanced Rectal Carcinoma. Ann Surg Oncol 14, 1870–1877 (2007). https://doi.org/10.1245/s10434-007-9385-9

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  • DOI: https://doi.org/10.1245/s10434-007-9385-9

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