Ann Surg Treat Res.  2015 Sep;89(3):131-137. 10.4174/astr.2015.89.3.131.

Outcomes of pelvic exenteration for recurrent or primary locally advanced colorectal cancer

• Yang HY
• Park SC
• Hyun JH
• Seo HK
• Oh JH

• KMID: 2166939
• DOI: http://doi.org/10.4174/astr.2015.89.3.131

Abstract

PURPOSE
The objective of this study was to assess the clinical outcomes of pelvic exenteration for patients with primary locally advanced colorectal cancer (LACRC) or locally recurrent colorectal cancer (LRCRC), and to identify clinically relevant prognostic factors.
METHODS
Between January 2001 and December 2010, 40 consecutive patients with primary LACRC or LRCRC underwent pelvic exenteration at the National Cancer Center, Republic of Korea. We retrospectively reviewed their medical records.
RESULTS
The median age was 59 years and the median follow-up time was 26 months (range, 1-117 months). The overall complication and in-hospital mortality rates were 70% (28/40) and 7.5% (3/40), respectively. The complication rates were similar between patients with primary LACRC (69.6%) and those with LRCRC (70.6%). The overall recurrence rate was 50% (17/34), and was lower in patients with primary LACRC than in patients with LRCRC (33.3% vs. 76.9%, P = 0.032). The 5-year overall survival was significantly different between primary LACRC and patients with LRCRC (58.7% vs. 11.8%, P = 0.022). Multivariate analysis revealed that radicality (R0 vs. R1/R2) was an independent prognostic factor for overall survival (P = 0.020).
CONCLUSION
The complication and operative mortality rates of pelvic exenteration remained high, but pelvic exenteration might provide an opportunity for long-term survival and good local control. Complete (R0) resection was the only independent prognostic factor for overall survival.

Keyword

Pelvic exenteration; Colorectal neoplasms; Local neoplasm recurrences

MeSH Terms

Colorectal Neoplasms*
Follow-Up Studies
Hospital Mortality
Humans
Medical Records
Mortality
Multivariate Analysis
Neoplasm Recurrence, Local
Pelvic Exenteration*
Recurrence
Republic of Korea
Retrospective Studies

Figure

• 

  Fig. 1 Kapla-Meier analysis of overall survival after pelvic exenteration in patients with primary advanced or recurrent colorectal cancer.

• 

  Fig. 2 Comparison of overall survival after pelvic exenteration between patients with primary locally advanced colorectal carcinoma and patients with locally recurrent colorectal cancer (Kaplan-Meier analysis; log-rank test, P = 0.022).

• 

  Fig. 3 Comparison of overall survival after complete (R0) and incomplete (R1 : R2) total pelvic exenteration (Kaplan-Meier analysis; log-rank test, P = 0.015).

Reference

1. Winter DC, Walsh R, Lee G, Kiely D, O'Riordain MG, O'Sullivan GC. Local involvement of the urinary bladder in primary colorectal cancer: outcome with enbloc resection. Ann Surg Oncol. 2007; 14:69–73.

2. Pawlik TM, Skibber JM, Rodriguez-Bigas MA. Pelvic exenteration for advanced pelvic malignancies. Ann Surg Oncol. 2006; 13:612–623.

3. Rahbari NN, Ulrich AB, Bruckner T, Munter M, Nickles A, Contin P, et al. Surgery for locally recurrent rectal cancer in the era of total mesorectal excision: is there still a chance for cure. Ann Surg. 2011; 253:522–533.

4. Wanebo HJ, Antoniuk P, Koness RJ, Levy A, Vezeridis M, Cohen SI, et al. Pelvic resection of recurrent rectal cancer: technical considerations and outcomes. Dis Colon Rectum. 1999; 42:1438–1448.

5. Brunschwig A. 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. 1948; 1:177–183.

6. Nielsen MB, Rasmussen PC, Lindegaard JC, Laurberg S. A 10-year experience of total pelvic exenteration for primary advanced and locally recurrent rectal cancer based on a prospective database. Colorectal Dis. 2012; 14:1076–1083.

7. Gannon CJ, Zager JS, Chang GJ, Feig BW, Wood CG, Skibber JM, et al. Pelvic exenteration affords safe and durable treatment for locally advanced rectal carcinoma. Ann Surg Oncol. 2007; 14:1870–1877.

8. Lopez-Basave HN, Morales-Vasquez F, Herrera-Gomez A, Rosciano AP, Meneses-Garcia A, Ruiz-Molina JM. Pelvic exenteration for colorectal cancer: oncologic outcome in 59 patients at a single institution. Cancer Manag Res. 2012; 4:351–356.

9. Kakuda JT, Lamont JP, Chu DZ, Paz IB. The role of pelvic exenteration in the management of recurrent rectal cancer. Am J Surg. 2003; 186:660–664.

10. Vermaas M, Ferenschild FT, Verhoef C, Nuyttens JJ, Marinelli AW, Wiggers T, et al. Total pelvic exenteration for primary locally advanced and locally recurrent rectal cancer. Eur J Surg Oncol. 2007; 33:452–458.

11. Domes TS, Colquhoun PH, Taylor B, Izawa JI, House AA, Luke PP, et al. Total pelvic exenteration for rectal cancer: outcomes and prognostic factors. Can J Surg. 2011; 54:387–393.

12. Ishiguro S, Akasu T, Fujita S, Yamamoto S, Kusters M, Moriya Y. Pelvic exenteration for clinical T4 rectal cancer: oncologic outcome in 93 patients at a single institution over a 30-year period. Surgery. 2009; 145:189–195.

13. Kang H, Kim HG, Ju JK, Kim DY. Multivisceral resection for locally advanced rectal cancer: adequate length of distal resection margin. J Korean Surg Soc. 2012; 82:87–93.

14. Bouchard P, Efron J. Management of recurrent rectal cancer. Ann Surg Oncol. 2010; 17:1343–1356.

15. 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; 45:1078–1084.

16. Lee JH, Kim DY, Kim SY, Park JW, Choi HS, Oh JH, et al. Clinical outcomes of chemoradiotherapy for locally recurrent rectal cancer. Radiat Oncol. 2011; 6:51.

17. Ike H, Shimada H, Ohki S, Yamaguchi S, Ichikawa Y, Fujii S. Outcome of total pelvic exenteration for locally recurrent rectal cancer. Hepatogastroenterology. 2003; 50:700–703.

18. Nishio M, Sakakura C, Nagata T, Miyashita A, Hamada T, Ikoma H, et al. Outcomes of total pelvic exenteration for colorectal cancer. Hepatogastroenterology. 2009; 56:1637–1641.

19. Abdelrazeq AS, Scott N, Thorn C, Verbeke CS, Ambrose NS, Botterill ID, et al. The impact of spontaneous tumour perforation on outcome following colon cancer surgery. Colorectal Dis. 2008; 10:775–780.