• Aneel Bhangu, S Mohammed Ali, Gina Brown, R John Nicholls, and Paris Tekkis.
• *Department of Colorectal Surgery, the Royal Marsden Hospital, London †Division of Surgery, Chelsea and Westminster Campus, Imperial College London, London ‡Department of Radiology, the Royal Marsden Hospital, London; and §Division of Surgery, Imperial College, St Mary's Hospital, London.
• Ann. Surg.. 2014 Feb 1;259(2):315-22.

ObjectiveThe outcome of pelvic exenteration was compared in patients with locally advanced primary (LAP) cancer and recurrent rectal cancer (RRC).BackgroundThere are few reports comparing the results of pelvic exenteration for primary advanced rectal cancer and RRC.MethodsConsecutive patients undergoing pelvic exenteration between 2006 and 2011 were identified from a prospectively maintained database. The main endpoints were 3-year disease-free survival (DFS) and local recurrence-free survival (LRFS).ResultsOf 100 exenterative operations, 55 were for LAP cancer and 45 for RRC. Exenteration of 1 pelvic compartment was required in 30 cases, 2 compartments in 49 cases, and 3 of 4 compartments in 21 cases. R0, R1, and R2 resections were achieved in 78, 15, and 7 cases, respectively. R0 rates were significantly higher in LAP cancer than in RRC (91% vs 62%, P = 0.001). Three-year DFS for R0, R1, and R2 resections was 67%, 49%, and 0%, respectively (P < 0.001). For R0 resections only, DFS in LAP cancer was 76% and 57% in RRC (P = 0.212). On multivariate analysis, a positive resection margin (hazard ratio, 4.04; P < 0.001) and positive lymph node staging (hazard ratio, 2.43; P = 0.022) were significant predictors of reduced DFS. Three-year LRFS for R0 resection was 86% for LAP cancer and 84% for RRC (P = 0.817). On multivariate analysis, only a positive resection margin was a significant predictor of reduced LRFS (hazard ratio, 5.48; P = 0.002).ConclusionsResection margin status is more important than primary or recurrent cancer in predicting long-term outcome.

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