• Craig A Harris, Michael J Solomon, Alexander G Heriot, Peter M Sagar, Paris P Tekkis, Liane Dixon, Rebecca Pascoe, Bruce R Dobbs, Chris M Frampton, Deena P Harji, Christos Kontovounisios, Kirk K Austin, Cherry E Koh, Peter J Lee, Andrew C Lynch, Satish K Warrier, and Frank A Frizelle.
• *Christchurch Hospital, Christchurch, New Zealand†Royal Prince Alfred Hospital, Sydney, Australia‡Peter MacCallum Cancer Centre, Melbourne, Australia§St James Hospital, Leeds, UK¶The Royal Marsden Hospital, London, UK.
• Ann. Surg. 2016 Aug 1; 264 (2): 323-9.

ObjectiveTo assess the outcomes and patterns of treatment failure of patients who underwent pelvic exenteration surgery for recurrent rectal cancer.BackgroundDespite advances in the management of rectal cancer, local recurrence still occurs. For appropriately selected patients, pelvic exenteration surgery can achieve long-term disease control.MethodsProspectively maintained databases of 5 high volume institutions for pelvic exenteration surgery were reviewed and data combined. We assessed the combined endpoints of overall 5-year survival, cancer-specific 5-year mortality, local recurrence, and the development of metastatic disease.ResultsFive hundred thirty-three patients who had undergone surgery for locally recurrent rectal cancer were identified. Five-year cancer-specific survival for patients with a complete (R0) resection is 44%, which was achieved in 59% of patients. For those with R1 and R2 resections, the 5-year survival was 26% and 10%, respectively. Radical resection required sacrectomy in 170 patients (32%), and total cystectomy in 105 patients (20%). Treatment failure included local recurrence alone in 75 patients (14%) and systemic metastases with or without local recurrence in 226 patients (42%). Chemoradiotherapy before exenteration was associated with a significant (P < 0.05) improvement in overall 5-year cancer-specific survival for those patients with an R0 resection. Postoperative chemotherapy did not alter outcomes.ConclusionsR0 resection of the pelvic recurrence is the most significant factor affecting overall and disease-free survival. The surgery is complex and often highly morbid, and where possible patients should be given perioperative chemoradiotherapy. Further investigations are required to determine the role of adjuvant chemotherapy.

37 keywords...

hide…