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1. Minimum standards of pelvic exenterative practice:PelvEx Collaborative guideline

Author

Fahy, MR, Kelly, ME, Aalbers, AGJ, Abdul Aziz, N, Abecasis, N, Abraham-Nordling, M, Akiyoshi, T, Alberda, W, Albert, M, Andric, M, Angeles, MA, Angenete, E, Antoniou, A, Auer, R, Austin, KK, Aytac, E, Aziz, O, Bacalbasa, N, Baker, RP, Bali, M, Baransi, S, Baseckas, G, Bebington, B, Bedford, M, Bednarski, BK, Beets, GL, Berg, PL, Bergzoll, C, Beynon, J, Biondo, S, Boyle, K, Bordeianou, L, Brecelj, E, Bremers, AB, Brunner, M, Buchwald, P, Bui, A, Burgess, A, Burger, JWA, Burling, D, Burns, E, Campain, N, Carvalhal, S, Castro, L, Caycedo-Marulanda, A, Ceelan, W, Chan, KKL, Chang, GJ, Chang, M, Chew, MH, Chok, AY, Chong, P, Clouston, H, Codd, M, Collins, D, Colquhoun, AJ, Constantinides, J, Corr, A, Coscia, M, Cosimelli, M, Cotsoglou, C, Coyne, PE, Croner, RS, Damjanovich, L, Daniels, IR, Davies, M, Delaney, CP, de Wilt, JHW, Denost, Q, Deutsch, C, Dietz, D, Domingo, S, Dozois, EJ, Drozdov, E, Duff, M, Eglinton, T, Enriquez-Navascues, JM, Espín-Basany, E, Evans, MD, Eyjólfsdóttir, B, Fearnhead, NS, Ferron, G, Flatmark, K, Fleming, FJ, Flor, B, Folkesson, J, Frizelle, FA, Funder, J, Gallego, MA, Gargiulo, M, García-Granero, E, García-Sabrido, JL, Gava, VG, Gentilini, L, George, ML, George, V, Georgiou, P, Ghosh, A, Ghouti, L, Gil-Moreno, A, Giner, F, Ginther, DN, Glyn, T, Glynn, R, Golda, T, Griffiths, B, Harris, DA, Hagemans, JAW, Hanchanale, V, Harji, DP, Helewa, RM, Hellawell, G, Heriot, AG, Hochman, D, Hohenberger, W, Holm, T, Hompes, R, Hornung, B, Hurton, S, Hyun, E, Ito, M, Iversen, LH, Jenkins, JT, Jourand, K, Kaffenberger, S, Kandaswamy, GV, Kapur, S, Kanemitsu, Y, Kazi, M, Kelley, SR, Keller, DS, Ketelaers, SHJ, Khan, MS, Kiran, RP, Kim, H, Kim, HJ, Koh, CE, Kok, NFM, Kokelaar, R, Kontovounisios, C, Kose, F, Koutra, M, Kristensen, HØ, Kroon, HM, Kumar, S, Kusters, M, Lago, V, Lampe, B, Lakkis, Z, Larach, JT, Larkin, JO, Larsen, SG, Larson, DW, Law, WL, Lee, PJ, Limbert, M, Loria, A, Lydrup, ML, Lyons, A, Lynch, AC, Maciel, J, Manfredelli, S, Mann, C, Mantyh, C, Mathis, KL, Marques, CFS, Martinez, A, Martling, A, Mehigan, BJ, Meijerink, WJHJ, Merchea, A, Merkel, S, Mehta, AM, Mikalauskas, S, McArthur, DR, McCormick, JJ, McCormick, P, McDermott, FD, McGrath, JS, Malde, S, Mirnezami, A, Monson, JRT, Navarro, AS, Negoi, I, Neto, JWM, Ng, JL, Nguyen, B, Nielsen, MB, Nieuwenhuijzen, GAP, Nilsson, PJ, Nordkamp, S, Nugent, T, Oliver, A, O’Dwyer, ST, O’Sullivan, NJ, Paarnio, K, Palmer, G, Pappou, E, Park, J, Patsouras, D, Peacock, O, Pellino, G, Peterson, AC, Pinson, J, Poggioli, G, Proud, D, Quinn, M, Quyn, A, Rajendran, N, Radwan, RW, Rao, C, Rasheed, S, Rausa, E, Regenbogen, SE, Reims, HM, Renehan, A, Rintala, J, Rocha, R, Rochester, M, Rohila, J, Rothbarth, J, Rottoli, M, Roxburgh, C, Rutten, HJT, Safar, B, Sagar, PM, Sahai, A, Saklani, A, Sammour, T, Sayyed, R, Schizas, AMP, Schwarzkopf, E, Scripcariu, D, Scripcariu, V, Selvasekar, C, Shaikh, I, Simpson, A, Skeie-Jensen, T, Smart, NJ, Smart, P, Smith, JJ, Solbakken, AM, Solomon, MJ, Sørensen, MM, Sorrentino, L, Steele, SR, Steffens, D, Stitzenberg, K, Stocchi, L, Stylianides, NA, Swartling, T, Spasojevic, M, Sumrien, H, Sutton, PA, Swartking, T, Takala, H, Tan, EJ, Taylor, C, Tekin, A, Tekkis, PP, Teras, J, Thaysen, HV, Thurairaja, R, Thorgersen, EB, Toh, EL, Tsarkov, P, Tsukada, Y, Tsukamoto, S, Tuech, JJ, Turner, WH, Tuynman, JB, Valente, M, van Ramshorst, GH, van Zoggel, D, Vasquez-Jimenez, W, Vather, R, Verhoef, C, Vierimaa, M, Vizzielli, G, Voogt, ELK, Uehara, K, Urrejola, G, Wakeman, C, Warrier, SK, Wasmuth, HH, Waters, PS, Weber, K, Weiser, MR, Wheeler, JMD, Wild, J, Williams, A, Wilson, M, Wolthuis, A, Yano, H, Yip, B, Yip, J, Yoo, RN, Zappa, MA, Winter, DC, Fahy, Mr, Kelly, Me, Aalbers, Agj, Abdul Aziz, N, Abecasis, N, Abraham-Nordling, M, Akiyoshi, T, Alberda, W, Albert, M, Andric, M, Angeles, Ma, Angenete, E, Antoniou, A, Auer, R, Austin, Kk, Aytac, E, Aziz, O, Bacalbasa, N, Baker, Rp, Bali, M, Baransi, S, Baseckas, G, Bebington, B, Bedford, M, Bednarski, Bk, Beets, Gl, Berg, Pl, Bergzoll, C, Beynon, J, Biondo, S, Boyle, K, Bordeianou, L, Brecelj, E, Bremers, Ab, Brunner, M, Buchwald, P, Bui, A, Burgess, A, Burger, Jwa, Burling, D, Burns, E, Campain, N, Carvalhal, S, Castro, L, Caycedo-Marulanda, A, Ceelan, W, Chan, Kkl, Chang, Gj, Chang, M, Chew, Mh, Chok, Ay, Chong, P, Clouston, H, Codd, M, Collins, D, Colquhoun, Aj, Constantinides, J, Corr, A, Coscia, M, Cosimelli, M, Cotsoglou, C, Coyne, Pe, Croner, R, Damjanovich, L, Daniels, Ir, Davies, M, Delaney, Cp, de Wilt, Jhw, Denost, Q, Deutsch, C, Dietz, D, Domingo, S, Dozois, Ej, Drozdov, E, Duff, M, Eglinton, T, Enriquez-Navascues, Jm, Espín-Basany, E, Evans, Md, Eyjólfsdóttir, B, Fearnhead, N, Ferron, G, Flatmark, K, Fleming, Fj, Flor, B, Folkesson, J, Frizelle, Fa, Funder, J, Gallego, Ma, Gargiulo, M, García-Granero, E, García-Sabrido, Jl, Gava, Vg, Gentilini, L, George, Ml, George, V, Georgiou, P, Ghosh, A, Ghouti, L, Gil-Moreno, A, Giner, F, Ginther, Dn, Glyn, T, Glynn, R, Golda, T, Griffiths, B, Harris, Da, Hagemans, Jaw, Hanchanale, V, Harji, Dp, Helewa, Rm, Hellawell, G, Heriot, Ag, Hochman, D, Hohenberger, W, Holm, T, Hompes, R, Hornung, B, Hurton, S, Hyun, E, Ito, M, Iversen, Lh, Jenkins, Jt, Jourand, K, Kaffenberger, S, Kandaswamy, Gv, Kapur, S, Kanemitsu, Y, Kazi, M, Kelley, Sr, Keller, D, Ketelaers, Shj, Khan, M, Kiran, Rp, Kim, H, Kim, Hj, Koh, Ce, Kok, Nfm, Kokelaar, R, Kontovounisios, C, Kose, F, Koutra, M, Kristensen, Hø, Kroon, Hm, Kumar, S, Kusters, M, Lago, V, Lampe, B, Lakkis, Z, Larach, Jt, Larkin, Jo, Larsen, Sg, Larson, Dw, Law, Wl, Lee, Pj, Limbert, M, Loria, A, Lydrup, Ml, Lyons, A, Lynch, Ac, Maciel, J, Manfredelli, S, Mann, C, Mantyh, C, Mathis, Kl, Marques, Cf, Martinez, A, Martling, A, Mehigan, Bj, Meijerink, Wjhj, Merchea, A, Merkel, S, Mehta, Am, Mikalauskas, S, Mcarthur, Dr, Mccormick, Jj, Mccormick, P, Mcdermott, Fd, Mcgrath, J, Malde, S, Mirnezami, A, Monson, Jrt, Navarro, A, Negoi, I, Neto, Jwm, Ng, Jl, Nguyen, B, Nielsen, Mb, Nieuwenhuijzen, Gap, Nilsson, Pj, Nordkamp, S, Nugent, T, Oliver, A, O’Dwyer, St, O’Sullivan, Nj, Paarnio, K, Palmer, G, Pappou, E, Park, J, Patsouras, D, Peacock, O, Pellino, G, Peterson, Ac, Pinson, J, Poggioli, G, Proud, D, Quinn, M, Quyn, A, Rajendran, N, Radwan, Rw, Rao, C, Rasheed, S, Rausa, E, Regenbogen, Se, Reims, Hm, Renehan, A, Rintala, J, Rocha, R, Rochester, M, Rohila, J, Rothbarth, J, Rottoli, M, Roxburgh, C, Rutten, Hjt, Safar, B, Sagar, Pm, Sahai, A, Saklani, A, Sammour, T, Sayyed, R, Schizas, Amp, Schwarzkopf, E, Scripcariu, D, Scripcariu, V, Selvasekar, C, Shaikh, I, Simpson, A, Skeie-Jensen, T, Smart, Nj, Smart, P, Smith, Jj, Solbakken, Am, Solomon, Mj, Sørensen, Mm, Sorrentino, L, Steele, Sr, Steffens, D, Stitzenberg, K, Stocchi, L, Stylianides, Na, Swartling, T, Spasojevic, M, Sumrien, H, Sutton, Pa, Swartking, T, Takala, H, Tan, Ej, Taylor, C, Tekin, A, Tekkis, Pp, Teras, J, Thaysen, Hv, Thurairaja, R, Thorgersen, Eb, Toh, El, Tsarkov, P, Tsukada, Y, Tsukamoto, S, Tuech, Jj, Turner, Wh, Tuynman, Jb, Valente, M, van Ramshorst, Gh, van Zoggel, D, Vasquez-Jimenez, W, Vather, R, Verhoef, C, Vierimaa, M, Vizzielli, G, Voogt, Elk, Uehara, K, Urrejola, G, Wakeman, C, Warrier, Sk, Wasmuth, Hh, Waters, P, Weber, K, Weiser, Mr, Wheeler, Jmd, Wild, J, Williams, A, Wilson, M, Wolthuis, A, Yano, H, Yip, B, Yip, J, Yoo, Rn, Zappa, Ma, Winter, Dc, Surgery, CCA - Cancer Treatment and quality of life, CCA - Imaging and biomarkers, and Amsterdam Gastroenterology Endocrinology Metabolism

Subjects
Neoplasm Recurrence, Local/surgery, Humans, Surgery, Neoplasm Recurrence, Local, Pelvic Exenteration
Abstract

This document outlines the important aspects of caring for patients who have been diagnosed with advanced pelvic cancer. It is primarily aimed at those who are establishing a service that adequately caters to this patient group. The relevant literature has been summarized and an attempt made to simplify the approach to management of these complex cases.

Published
2022
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2. Laparoscopic versus open colorectal surgery in the acute setting (LaCeS trial): a multicentre randomized feasibility trial

Author

Harji, DP, Marshall, H, Gordon, K, Twiddy, M, Pullan, A, Meads, D, Croft, J, Burke, D, Griffiths, B, Verjee, A, Sagar, P, Stocken, D, Brown, J, and the LaCeS Collaborators

Abstract

Background Approximately 30 000 people undergo major emergency abdominal gastrointestinal surgery annually, and 36 per cent of these procedures (around 10 800) are carried out for emergency colorectal pathology. Some 14 per cent of all patients requiring emergency surgery have a laparoscopic procedure. The aims of the LaCeS (laparoscopic versus open colorectal surgery in the acute setting) feasibility trial were to assess the feasibility, safety and acceptability of performing a large‐scale definitive phase III RCT, with a comparison of emergency laparoscopic versus open surgery for acute colorectal pathology. Methods LaCeS was designed as a prospective, multicentre, single‐blind, parallel‐group, pragmatic feasibility RCT with an integrated qualitative study. Randomization was undertaken centrally, with patients randomized on a 1 : 1 basis between laparoscopic or open surgery. Results A total of 64 patients were recruited across five centres. The overall mean steady‐state recruitment rate was 1·2 patients per month per site. Baseline compliance for clinical and health‐related quality‐of‐life data was 99·8 and 93·8 per cent respectively. The conversion rate from laparoscopic to open surgery was 39 (95 per cent c.i. 23 to 58) per cent. The 30‐day postoperative complication rate was 27 (13 to 46) per cent in the laparoscopic arm and 42 (25 to 61) per cent in the open arm. Conclusion Laparoscopic emergency colorectal surgery may have an acceptable safety profile. Registration number: ISRCTN15681041 ( http://www.controlled‐trials.com).

Published
2020

3. Pelvic Exenteration for Advanced Nonrectal Pelvic Malignancy

Author

Kelly ME, Ryan E ´ J, Aalbers AGJ, Abdul Aziz N, Abraham-Nordling M, Alberda W, Antoniou A, Austin KK, Baker R, Bali M, Baseckas G, Bednarski BK, Beets GL, Berg PL, Beynon J, Biondo S, Bordeianou L, Bremers AB, Brunner M, Buchwald P, Burger JWA, Burling D, Campain N, Chan KKL, Chang GJ, Chew MH, C Chong P, Christensen HK, Codd M, Colquhoun AJ, Corr A, Coscia M, Coyne PE, Creavin B, Damjanovic L, Daniels IR, Davies M, Davies RJ, deWilt JHW, Denost Q, Deutsch C, Dietz D, Domingo S, Dozois EJ, Duff M, Eglinton T, Evans MD, Fearnhead NS, Frizelle FA, Garcia-Granero E, Garcia-Sabrido JL, GentiliniL, George ML, Glynn R, Golda T, Griffiths B, Harris DA, Evans M, Hagemans JAW, Harji DP, Heriot AG, HohenbergerW, Holm T, Humphries E, Jansson-Palmer G, Jenkins JT, Kapur S, Kanemitsu Y, Kelley SR, Keller DS, Kim H, Koh CE, Kok NFM, Kokelaar R, Kontovounisios C, Kroon H, Kusters M, Lago V, Larson DW, Law WL, Laurberg S, Lee P, Lydrup ML, Lynch AC, Mathis KL, Martling A, Meijerink WJHJ, Merkel S, Mehta AM, McDermott FD, McGrath JS, Mihailo A, Mirnezami A, Morton JR, Mullaney TG, Nielsen MB, Nieuwenhuijzen GAP, Nilsson PJ, O’Connell PR, Palmer G, Patsouras D, Pellino G, Poggioli G, Quinn M, Quyn A, Radwan RW, Rasheed S, Rasmussen PC, Rocha R, Rothbarth J, Roxburgh C, Rutten HJT, Sagar PM, Sammour T, Schizas AMP, Schwarzkopf E, Scripcariu V, Shaikh I, Shida D, Simpson A, Smart NJ, Smith JJ, Solomon MJ, Sørensen MM, Steele SR, Steffens D, Stocchi L, Stylianides NA, Tekkis PP, Taylor C, Tsukamoto S, Turner WH, Tuynman JB, vanRamshorst GH, van Zoggel D, Vasquez-JimenezW, Verhoef C, WakemanC, Warrier S, Wasmuth HH, Weiser MR, Wheeler JMD, Wild J, Yip J, Winter DC., Gilberto Poggioli, Kelly, Me, Ryan, E ´ J, Aalbers, Agj, Abdul Aziz, N, Abraham-Nordling, M, Alberda, W, Antoniou, A, Austin, Kk, Baker, R, Bali, M, Baseckas, G, Bednarski, Bk, Beets, Gl, Berg, Pl, Beynon, J, Biondo, S, Bordeianou, L, Bremers, Ab, Brunner, M, Buchwald, P, Burger, Jwa, Burling, D, Campain, N, Chan, Kkl, Chang, Gj, Chew, Mh, C Chong, P, Christensen, Hk, Codd, M, Colquhoun, Aj, Corr, A, Coscia, M, Coyne, Pe, Creavin, B, Damjanovic, L, Daniels, Ir, Davies, M, Davies, Rj, Dewilt, Jhw, Denost, Q, Deutsch, C, Dietz, D, Domingo, S, Dozois, Ej, Duff, M, Eglinton, T, Evans, Md, Fearnhead, N, Frizelle, Fa, Garcia-Granero, E, Garcia-Sabrido, Jl, Gentilinil, George, Ml, Glynn, R, Golda, T, Griffiths, B, Harris, Da, Evans, M, Hagemans, Jaw, Harji, Dp, Heriot, Ag, Hohenbergerw, Holm, T, Humphries, E, Jansson-Palmer, G, Jenkins, Jt, Kapur, S, Kanemitsu, Y, Kelley, Sr, Keller, D, Kim, H, Koh, Ce, Kok, Nfm, Kokelaar, R, Kontovounisios, C, Kroon, H, Kusters, M, Lago, V, Larson, Dw, Law, Wl, Laurberg, S, Lee, P, Lydrup, Ml, Lynch, Ac, Mathis, Kl, Martling, A, Meijerink, Wjhj, Merkel, S, Mehta, Am, Mcdermott, Fd, Mcgrath, J, Mihailo, A, Mirnezami, A, Morton, Jr, Mullaney, Tg, Nielsen, Mb, Nieuwenhuijzen, Gap, Nilsson, Pj, O’Connell, Pr, Palmer, G, Patsouras, D, Pellino, G, Poggioli, G, Quinn, M, Quyn, A, Radwan, Rw, Rasheed, S, Rasmussen, Pc, Rocha, R, Rothbarth, J, Roxburgh, C, Rutten, Hjt, Sagar, Pm, Sammour, T, Schizas, Amp, Schwarzkopf, E, Scripcariu, V, Shaikh, I, Shida, D, Simpson, A, Smart, Nj, Smith, Jj, Solomon, Mj, Sørensen, Mm, Steele, Sr, Steffens, D, Stocchi, L, Stylianides, Na, Tekkis, Pp, Taylor, C, Tsukamoto, S, Turner, Wh, Tuynman, Jb, Vanramshorst, Gh, van Zoggel, D, Vasquez-JimenezW, Verhoef, C, Wakemanc, Warrier, S, Wasmuth, Hh, Weiser, Mr, Wheeler, Jmd, Wild, J, Yip, J, and Winter, Dc.

Subjects
Pelvic Neoplasm, Databases, Factual, medicine.medical_treatment, Tertiary Care Center, Kaplan-Meier Estimate, Cohort Studies, Tertiary Care Centers, Tumours of the digestive tract Radboud Institute for Health Sciences [Radboudumc 14], 0302 clinical medicine, Retrospective Studie, Cause of Death, Pelvic Neoplasms, Neoadjuvant therapy, Cervical cancer, Aged, 80 and over, Mortality rate, Middle Aged, Prognosis, 030220 oncology & carcinogenesis, 030211 gastroenterology & hepatology, Female, Survival Analysi, Human, medicine.medical_specialty, Prognosi, Malignancy, Risk Assessment, Disease-Free Survival, 03 medical and health sciences, SDG 3 - Good Health and Well-being, medicine, Humans, Neoplasm Invasiveness, Survival analysis, Proportional Hazards Models, Retrospective Studies, Aged, Neoplasm Staging, Neoplasm Invasivene, Pelvic exenteration, business.industry, medicine.disease, Survival Analysis, Surgery, Pelvic Exenteration, Proportional Hazards Model, Cohort Studie, Neoplasm Recurrence, Local, Ovarian cancer, business
Abstract

Item does not contain fulltext OBJECTIVE: To determine factors associated with outcomes following pelvic exenteration for advanced nonrectal pelvic malignancy. BACKGROUND: The PelvEx Collaborative provides large volume data from specialist centers to ascertain factors associated with improved outcomes. METHODS: Consecutive patients who underwent pelvic exenteration for nonrectal pelvic malignancy between 2006 and 2017 were identified from 22 tertiary centers. Patient demographics, neoadjuvant therapy, histopathological assessment, length of stay, 30-day major complication/mortality rate were recorded.The primary endpoints were factors associated with survival. The secondary endpoints included the difference in margin rates across the cohorts, impact of neoadjuvant treatment on survival, associated morbidity, and mortality. RESULTS: One thousand two hundred ninety-three patients were identified. 40.4% (n = 523) had gynecological malignancies (endometrial, ovarian, cervical, and vaginal), 35.7% (n = 462) urological (bladder), 18.1% (n = 234) anal, and 5.7% had sarcoma (n = 74).The median age across the cohort was 63 years (range, 23-85). The median 30-day mortality rate was 1.7%, with the highest rates occurring following exenteration for recurrent sarcoma or locally advanced cervical cancer (3.3% each). The median length of hospital stay was 17.5 days. 34.5% of patients experienced a major complication, with highest rate occurring in those having salvage surgery for anal cancer.Multivariable analysis showed R0 resection was the main factor associated with long-term survival. The 3-year overall-survival rate for R0 resection was 48% for endometrial malignancy, 40.6% for ovarian, 49.4% for cervical, 43.8% for vaginal, 59% for bladder, 48.3% for anal, and 48.1% for sarcoma. CONCLUSION: Pelvic exenteration remains an important treatment in selected patients with advanced or recurrent nonrectal pelvic malignancy. The range in 3-year overall survival following R0 resection (40%-59%) reflects the diversity of tumor types.

Published
2019

4. Systematic review of definitions and outcome measures for return of bowel function after gastrointestinal surgery

Author

Chapman, SJ, Thorpe, G, Vallance, AE, Harji, DP, Lee, MJ, and Fearnhead, NS

Abstract

Background\ud Ileus is common after gastrointestinal surgery and has been identified as a research priority. Several issues have limited previous research, including a widely accepted definition and agreed outcome measure. This review is the first stage in the development of a core outcome set for the return of bowel function after gastrointestinal surgery. It aims to characterize the extent of variation in current outcome reporting.\ud \ud Methods\ud A systematic search of MEDLINE, Embase, CINAHL (Cumulative Index to Nursing and Allied Health Literature) and the Cochrane Library was performed for 1990–2017. RCTs of adults undergoing gastrointestinal surgery, including at least one reported measure relating to return of bowel function, were eligible. Trial registries were searched across the same period for ongoing and completed (but not published) RCTs. Definitions of ileus and outcome measures describing the return of bowel function were extracted.\ud \ud Results\ud Of 5670 manuscripts screened, 215 (reporting 217 RCTs) were eligible. Most RCTs involved patients undergoing colorectal surgery (161 of 217, 74·2 per cent). A total of 784 outcomes were identified across all published RCTs, comprising 73 measures (clinical: 63, 86 per cent; radiological: 6, 8 per cent; physiological: 4, 5 per cent). The most commonly reported outcome measure was ‘time to first passage of flatus’ (140 of 217, 64·5 per cent). The outcomes ‘ileus’ and ‘prolonged ileus’ were defined infrequently and variably.\ud \ud Conclusion\ud Outcome reporting for the return of bowel function after gastrointestinal surgery is variable and not fit for purpose. An agreed core outcome set will improve the consistency, reliability and clinical value of future studies.

Published
2019

5. Simultaneous pelvic exenteration and liver resection for primary rectal cancer with synchronous liver metastases: results from the PelvEx Collaborative

Author

Kelly, M. E., Aalbers, A. G. J., Abdul Aziz, N., Abecasis, N., Abraham‐Nordling, M., Akiyoshi, T., Alberda, W., Albert, M., Andric, M., Angenete, E., Antoniou, A., Auer, R., Austin, K. K., Aziz, O., Baker, R. P., Bali, M., Baseckas, G., Bebington, B., Bednarski, B. K., Beets, G. L., Berg, P. L., Beynon, J., Biondo, S., Boyle, K., Bordeianou, L., Bremers, A. B., Brunner, M., Buchwald, P., Bui, A., Burgess, A., Burger, J. W. A., Burling, D., Burns, E., Campain, N., Carvalhal, S., Castro, L., Caycedo‐Marulanda, A., Chan, K. K. L., Chang, G. J., Chew, M. H., Chong, P. C., Christensen, H. K., Clouston, H., Codd, M., Collins, D., Colquhoun, A. J., Corr, A., Coscia, M., Coyne, P. E., Creavin, B., Croner, R. S., Damjanovic, L., Daniels, I. R., Davies, M., Davies, R. J., Delaney, C. P., Denost, Q., Deutsch, C., Dietz, D., Domingo, S., Dozois, E. J., Duff, M., Eglinton, T., Enrique‐Navascues, J. M., Espin‐Basany, E., Evans, M. D., Fearnhead, N. S., Flatmark, K., Fleming, F., Frizelle, F. A., Gallego, M. A., Garcia‐Granero, E., Garcia‐Sabrido, J. L., Gentilini, L., George, M. L., Ghouti, L., Giner, F., Ginther, N., Glynn, R., Golda, T., Griffiths, B., Harris, D. A., Hagemans, J. A. W., Hanchanale, V., Harji, D. P., Helewa, R. M., Heriot, A. G., Hochman, D., Hohenberger, W., Holm, T., Hompes, R., Jenkins, J. T., Kaffenberger, S., Kandaswamy, G. V., Kapur, S., Kanemitsu, Y., Kelley, S. R., Keller, D. S., Khan, M. S., Kiran, R. P., Kim, H., Kim, H. J., Koh, C. E., Kok, N. F. M., Kokelaar, R., Kontovounisios, C., Kristensen, H. Ø., Kroon, H. M., Kusters, M., Lago, V., Larsen, S. G., Larson, D. W., Law, W. L., Laurberg, S., Lee, P. J., Limbert, M., Lydrup, M. L., Lyons, A., Lynch, A. C., Mantyh, C., Mathis, K. L., Margues, C. F. S., Martling, A., Meijerink, W. J. H. J., Merkel, S., Mehta, A. M., McArthur, D. R., McDermott, F. D., McGrath, J. S., Malde, S., Mirnezami, A., Monson, J. R. T., Morton, J. R., Mullaney, T. G., Negoi, I., Neto, J. W. M., Nguyen, B., Nielsen, M. B., Nieuwenhuijzen, G. A. P., Nilsson, P. J., O’Connell, P. R., O’Dwyer, S. T., Palmer, G., Pappou, E., Park, J., Patsouras, D., Pellino, G., Peterson, A. C., Poggioli, G., Proud, D., Quinn, M., Quyn, A., Radwan, R. W., van Ramshorst, G. H., Rasheed, S., Rasmussen, P. C., Regenbogen, S. E., Renehan, A., Rocha, R., Rochester, M., Rohila, J., Rothbarth, J., Rottoli, M., Roxburgh, C., Rutten, H. J. T., Ryan, É. J., Safar, B., Sagar, P. M., Sahai, A., Saklani, A., Sammour, T., Sayyed, R., Schizas, A. M. P., Schwarzkopf, E., Scripcariu, V., Selvasekar, C., Shaikh, I., Hellawell, G., Shida, D., Simpson, A., Smart, N. J., Smart, P., Smith, J. J., Solbakken, A. M., Solomon, M. J., Sørensen, M. M., Steele, S. R., Steffens, D., Stitzenberg, K., Stocchi, L., Stylianides, N. A., Sumrien, H., Sutton, P. A., Swartking, T., Taylor, C., Tekkis, P. P., Teras, J., Thurairaja, R., Toh, E. L., Tsarkov, P., Tsukada, Y., Tsukamoto, S., Tuech, J. J., Turner, W. H., Tuynman, J. B., Vasquez‐Jimenez, W., Verhoef, C., Vizzielli, G., Voogt, E. L. K., Uehara, K., Wakeman, C., Warrier, S., Wasmuth, H. H., Weber, K., Weiser, M. R., Wheeler, J. M. D., Wild, J., Wilson, M., de Wilt, J. H. W., Wolthuis, A., Yano, H., Yip, B., Yip, J., Yoo, R. N., van Zoggel, D., Winter, D. C., Kelly, M. E., Aalbers, A. G. J., Abdul Aziz, N., Abecasis, N., Abraham‐nordling, M., Akiyoshi, T., Alberda, W., Albert, M., Andric, M., Angenete, E., Antoniou, A., Auer, R., Austin, K. K., Aziz, O., Baker, R. P., Bali, M., Baseckas, G., Bebington, B., Bednarski, B. K., Beets, G. L., Berg, P. L., Beynon, J., Biondo, S., Boyle, K., Bordeianou, L., Bremers, A. B., Brunner, M., Buchwald, P., Bui, A., Burgess, A., Burger, J. W. A., Burling, D., Burns, E., Campain, N., Carvalhal, S., Castro, L., Caycedo‐marulanda, A., Chan, K. K. L., Chang, G. J., Chew, M. H., Chong, P. C., Christensen, H. K., Clouston, H., Codd, M., Collins, D., Colquhoun, A. J., Corr, A., Coscia, M., Coyne, P. E., Creavin, B., Croner, R. S., Damjanovic, L., Daniels, I. R., Davies, M., Davies, R. J., Delaney, C. P., Denost, Q., Deutsch, C., Dietz, D., Domingo, S., Dozois, E. J., Duff, M., Eglinton, T., Enrique‐navascues, J. M., Espin‐basany, E., Evans, M. D., Fearnhead, N. S., Flatmark, K., Fleming, F., Frizelle, F. A., Gallego, M. A., Garcia‐granero, E., Garcia‐sabrido, J. L., Gentilini, L., George, M. L., Ghouti, L., Giner, F., Ginther, N., Glynn, R., Golda, T., Griffiths, B., Harris, D. A., Hagemans, J. A. W., Hanchanale, V., Harji, D. P., Helewa, R. M., Heriot, A. G., Hochman, D., Hohenberger, W., Holm, T., Hompes, R., Jenkins, J. T., Kaffenberger, S., Kandaswamy, G. V., Kapur, S., Kanemitsu, Y., Kelley, S. R., Keller, D. S., Khan, M. S., Kiran, R. P., Kim, H., Kim, H. J., Koh, C. E., Kok, N. F. M., Kokelaar, R., Kontovounisios, C., Kristensen, H. Ø., Kroon, H. M., Kusters, M., Lago, V., Larsen, S. G., Larson, D. W., Law, W. L., Laurberg, S., Lee, P. J., Limbert, M., Lydrup, M. L., Lyons, A., Lynch, A. C., Mantyh, C., Mathis, K. L., Margues, C. F. S., Martling, A., Meijerink, W. J. H. J., Merkel, S., Mehta, A. M., Mcarthur, D. R., Mcdermott, F. D., Mcgrath, J. S., Malde, S., Mirnezami, A., Monson, J. R. T., Morton, J. R., Mullaney, T. G., Negoi, I., Neto, J. W. M., Nguyen, B., Nielsen, M. B., Nieuwenhuijzen, G. A. P., Nilsson, P. J., O’Connell, P. R., O’Dwyer, S. T., Palmer, G., Pappou, E., Park, J., Patsouras, D., Pellino, G., Peterson, A. C., Poggioli, G., Proud, D., Quinn, M., Quyn, A., Radwan, R. W., van Ramshorst, G. H., Rasheed, S., Rasmussen, P. C., Regenbogen, S. E., Renehan, A., Rocha, R., Rochester, M., Rohila, J., Rothbarth, J., Rottoli, M., Roxburgh, C., Rutten, H. J. T., Ryan, É. J., Safar, B., Sagar, P. M., Sahai, A., Saklani, A., Sammour, T., Sayyed, R., Schizas, A. M. P., Schwarzkopf, E., Scripcariu, V., Selvasekar, C., Shaikh, I., Hellawell, G., Shida, D., Simpson, A., Smart, N. J., Smart, P., Smith, J. J., Solbakken, A. M., Solomon, M. J., Sørensen, M. M., Steele, S. R., Steffens, D., Stitzenberg, K., Stocchi, L., Stylianides, N. A., Sumrien, H., Sutton, P. A., Swartking, T., Taylor, C., Tekkis, P. P., Teras, J., Thurairaja, R., Toh, E. L., Tsarkov, P., Tsukada, Y., Tsukamoto, S., Tuech, J. J., Turner, W. H., Tuynman, J. B., Vasquez‐jimenez, W., Verhoef, C., Vizzielli, G., Voogt, E. L. K., Uehara, K., Wakeman, C., Warrier, S., Wasmuth, H. H., Weber, K., Weiser, M. R., Wheeler, J. M. D., Wild, J., Wilson, M., de Wilt, J. H. W., Wolthuis, A., Yano, H., Yip, B., Yip, J., Yoo, R. N., van Zoggel, D., Winter, D. C., Kelly, ME, Aalbers, AGJ, Aziz, NA, Abecasis, N, Abraham-Nordling, M, Akiyoshi, T, Alberda, W, Albert, M, Andric, M, Angenete, E, Antoniou, A, Auer, R, Austin, KK, Aziz, O, Baker, RP, Bali, M, Baseckas, G, Bebington, B, Bednarski, BK, Beets, GL, Berg, PL, Beynon, J, Biondo, S, Boyle, K, Bordeianou, L, Bremers, AB, Brunner, M, Buchwald, P, Bui, A, Burgess, A, Burger, JWA, Burling, D, Burns, E, Campain, N, Carvalhal, S, Castro, L, Caycedo-Marulanda, A, Chan, KKL, Chew, GJH, Chong, PC, Christensen, HK, Clouston, H, Codd, M, Coffins, D, Colquhoun, AJ, Corr, A, Coscia, M, Coyne, PE, Creavin, B, Croner, RS, Damjanovic, L, Daniels, R, Davies, M, Davies, RJ, Delaney, CP, Denost, Q, Deutsch, C, Dietz, D, Domingo, S, Dozois, EJ, Duff, M, Eglinton, T, Enrique-Navascues, JM, Espin-Basany, E, Evans, MD, Fearnhead, NS, Flatmark, K, Fleming, F, Frizelle, FA, Gallego, MA, Garcia-Granero, E, Garcia-Sabrido, JL, Gentilini, L, George, ML, Ghouti, L, Giner, F, Ginther, N, Glynn, R, Golda, T, Griffiths, B, Harris, DA, Hagemans, JAW, Hanchanale, V, Harji, DP, Helewa, RM, Heriot, AG, Hochman, D, Hohenberger, W, Holm, T, Hompes, R, Jenkins, JT, Kaffenberger, S, Kandaswamy, GV, Kapur, S, Kanemitsu, Y, Kelley, SR, Keller, DS, Khan, MS, Kiran, RP, Kim, H, Kim, HJ, Koh, CE, Kok, NFM, Kokelaar, R, Kontovounisios, C, Kristensen, HO, Kroon, HM, Kusters, M, Lago, V, Larsen, SG, Larson, DW, Law, WL, Laurberg, S, Lee, PJ, Limbert, M, Lydrup, ML, Lyons, A, Lynch, AC, Mantyh, C, Mathis, KL, Margues, CFS, Martling, A, Meijerink, WJHJ, Merkel, S, Mehta, AM, McArthur, DR, McDermott, FD, McGrath, JS, Malde, S, Mimezami, A, Monson, JRT, Morton, JR, Mullaney, TG, Negoi, I, Neto, JWM, Nguyen, B, Nielsen, MB, Nieuwenhuijzen, GAP, Nilsson, PJ, O'Connell, PR, O'Dwyer, ST, Palmer, G, Pappou, E, Park, J, Patsouras, D, Pellino, G, Peterson, AC, Poggioli, G, Proud, D, Quinn, M, Quyn, A, Radwan, RW, van Ramshorst, GH, Rasheed, S, Rasmussen, PC, Regenbogen, SE, Renehan, A, Rocha, R, Rochester, M, Rohila, J, Rothbarth, J, Rottoli, M, Roxburgh, C, Rutten, HJT, Ryan, EJ, Safar, B, Sagar, PM, Sahai, A, Saklani, A, Sammour, T, Sayyed, R, Schizas, AMP, Schwarzkopf, E, Scripcariu, V, Selvasekar, C, Shaikh, I, Hellawell, G, Shida, D, Simpson, A, Smart, NJ, Smart, P, Smith, JJ, Solbakken, AM, Solomon, MJ, Sorensen, MM, Steele, SR, Steffens, D, Stitzenberg, K, Stocchi, L, Stylianides, NA, Sumrien, H, Sutton, PA, Swanking, T, Taylor, C, Tekkis, PP, Teras, J, Thurairaja, R, Toh, EL, Tsarkov, P, Tsukada, Y, Tsukamoto, S, Tuech, JJ, Turner, WH, Tuynman, JB, Vasquez-Jimenez, W, Verhoef, C, Vizzielli, G, Voogt, ELK, Uehara, K, Wakeman, C, Warner, S, Wasmuth, HH, Weber, K, Weiser, MR, Wheeler, JMD, Wild, J, Wilson, M, de Wilt, JHW, Wolthuis, A, Yano, H, Yip, B, Yip, J, Yoo, RN, van Zoggel, D, Winter, DC, Surgery, CCA - Cancer Treatment and quality of life, and Amsterdam Gastroenterology Endocrinology Metabolism

Subjects
Male, medicine.medical_specialty, Adolescent, Colorectal cancer, survival outcomes, medicine.medical_treatment, surgical outcome, surgical outcomes, Tumours of the digestive tract Radboud Institute for Health Sciences [Radboudumc 14], 03 medical and health sciences, 0302 clinical medicine, SDG 3 - Good Health and Well-being, Interquartile range, medicine, Humans, liver metastasi, Rectal cancer, Retrospective Studies, Pelvic exenteration, business.industry, Rectal Neoplasms, Mortality rate, Liver Neoplasms, Gastroenterology, Postoperative complication, Perioperative, medicine.disease, Surgery, Pelvic Exenteration, liver metastasis, Treatment Outcome, 030220 oncology & carcinogenesis, international collaboration, Resection margin, 030211 gastroenterology & hepatology, Hepatectomy, Neoplasm Recurrence, Local, business
Abstract

Aim: At presentation, 15–20% of patients with rectal cancer already have synchronous liver metastases. The aim of this study was to determine the surgical and survival outcomes in patients with advanced rectal cancer who underwent combined pelvic exenteration and liver (oligometastatic) resection. Method: Data from 20 international institutions that performed simultaneous pelvic exenteration and liver resection between 2007 and 2017 were accumulated. Primarily, we examined perioperative outcomes, morbidity and mortality. We also assessed the impact that margin status had on survival. Results: Of 128 patients, 72 (56.2%) were men with a median age of 60 years [interquartile range (IQR) 15 years]. The median size of the liver oligometastatic deposits was 2 cm (IQR 1.8 cm). The median duration of surgery was 406 min (IQR 240 min), with a median blood loss of 1090 ml (IQR 2010 ml). A negative resection margin (R0 resection) was achieved in 73.5% of pelvic exenterations and 66.4% of liver resections. The 30-day mortality rate was 1.6%, and 32% of patients had a major postoperative complication. The 5-year overall survival for patients in whom an R0 resection of both primary and metastatic disease was achieved was 54.6% compared with 20% for those with an R1/R2 resection (P = 0.006). Conclusion: Simultaneous pelvic exenteration and liver resection is feasible, with acceptable morbidity and mortality. Simultaneous resection should only be performed where an R0 resection of both pelvic and hepatic disease is anticipated.

Published
2020
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6. Palliative pelvic exenteration: A systematic review of patient-centered outcomes

Author

Hidde M. Kroon, N.N. Dudi-Venkata, S. Bedrikovetski, M.L. Thomas, M.E. Kelly, A.G.J. Aalbers, N. Abdul Aziz, M. Abraham-Nordling, T. Akiyoshi, W. Alberda, M. Andric, A. Antoniou, K.K. Austin, R.P. Baker, M. Bali, G. Baseckas, B.K. Bednarski, G.L. Beets, P.L. Berg, J. Beynon, S. Biondo, L. Bordeianou, M. Brunner, P. Buchwald, J.W.A. Burger, D. Burling, N. Campain, K.K.L. Chan, G.J. Chang, M.H. Chew, P. C Chong, H.K. Christensen, M. Codd, A.J. Colquhoun, A. Corr, M. Coscia, P.E. Coyne, B. Creavin, L. Damjanovic, I.R. Daniels, M. Davies, R.J. Davies, J.H.W. de Wilt, Q. Denost, D. Dietz, E.J. Dozois, M. Duff, T. Eglinton, J.M. Enriquez-Navascues, M.D. Evans, N.S. Fearnhead, F.A. Frizelle, E. Garcia-Granero, J.L. Garcia-Sabrido, L. Gentilini, M.L. George, R. Glynn, T. Golda, B. Griffiths, D.A. Harris, M. Evans, J.A.W. Hagemans, D.P. Harji, A.G. Heriot, W. Hohenberger, T. Holm, J.T. Jenkins, S. Kapur, Y. Kanemitsu, S.R. Kelley, D.S. Keller, H. Kim, C.E. Koh, N.F.M. Kok, R. Kokelaar, C. Kontovounisios, M. Kusters, D.W. Larson, W.L. Law, S. Laurberg, P. Lee, M.L. Lydrup, A.C. Lynch, C. Mantyh, K.L. Mathis, A. Martling, W.J.H.J. Meijerink, S. Merkel, A.M. Mehta, F.D. McDermott, J.S. McGrath, A. Mirnezami, J.R. Morton, T.G. Mullaney, J.W. Mesquita-Neto, M.B. Nielsen, G.A.P. Nieuwenhuijzen, P.J. Nilsson, P.R. O'Connell, G. Palmer, D. Patsouras, G. Pellino, G. Poggioli, M. Quinn, A. Quyn, R.W. Radwan, S. Rasheed, P.C. Rasmussen, S.E. Regenbogen, R. Rocha, J. Rothbarth, C. Roxburgh, H.J.T. Rutten, É. Ryan, P.M. Sagar, A. Saklani, A.M.P. Schizas, E. Schwarzkopf, V. Scripcariu, I. Shaikh, D. Shida, A. Simpson, N.J. Smart, J.J. Smith, M.J. Solomon, M.M. Sørensen, S.R. Steele, D. Steffens, L. Stocchi, N.A. Stylianides, P.P. Tekkis, C. Taylor, P. Tsarkov, S. Tsukamoto, W.H. Turner, J.B. Tuynman, G.H. van Ramshorst, D. van Zoggel, W. Vasquez-Jimenez, C. Verhoef, M. Verstegen, C. Wakeman, S. Warrier, H.H. Wasmuth, M.R. Weiser, J.M.D. Wheeler, J. Wild, J. Yip, D.C. Winter, T. Sammour, Kroon H.M., Dudi-Venkata N.N., Bedrikovetski S., Thomas M.L., Kelly M.E., Aalbers A.G.J., Abdul Aziz N., Abraham-Nordling M., Akiyoshi T., Alberda W., Andric M., Antoniou A., Austin K.K., Baker R.P., Bali M., Baseckas G., Bednarski B.K., Beets G.L., Berg P.L., Beynon J., Biondo S., Bordeianou L., Brunner M., Buchwald P., Burger J.W.A., Burling D., Campain N., Chan K.K.L., Chang G.J., Chew M.H., C Chong P., Christensen H.K., Codd M., Colquhoun A.J., Corr A., Coscia M., Coyne P.E., Creavin B., Damjanovic L., Daniels I.R., Davies M., Davies R.J., de Wilt J.H.W., Denost Q., Dietz D., Dozois E.J., Duff M., Eglinton T., Enriquez-Navascues J.M., Evans M.D., Fearnhead N.S., Frizelle F.A., Garcia-Granero E., Garcia-Sabrido J.L., Gentilini L., George M.L., Glynn R., Golda T., Griffiths B., Harris D.A., Evans M., Hagemans J.A.W., Harji D.P., Heriot A.G., Hohenberger W., Holm T., Jenkins J.T., Kapur S., Kanemitsu Y., Kelley S.R., Keller D.S., Kim H., Koh C.E., Kok N.F.M., Kokelaar R., Kontovounisios C., Kusters M., Larson D.W., Law W.L., Laurberg S., Lee P., Lydrup M.L., Lynch A.C., Mantyh C., Mathis K.L., Martling A., Meijerink W.J.H.J., Merkel S., Mehta A.M., McDermott F.D., McGrath J.S., Mirnezami A., Morton J.R., Mullaney T.G., Mesquita-Neto J.W., Nielsen M.B., Nieuwenhuijzen G.A.P., Nilsson P.J., O'Connell P.R., Palmer G., Patsouras D., Pellino G., Poggioli G., Quinn M., Quyn A., Radwan R.W., Rasheed S., Rasmussen P.C., Regenbogen S.E., Rocha R., Rothbarth J., Roxburgh C., Rutten H.J.T., Ryan E., Sagar P.M., Saklani A., Schizas A.M.P., Schwarzkopf E., Scripcariu V., Shaikh I., Shida D., Simpson A., Smart N.J., Smith J.J., Solomon M.J., Sorensen M.M., Steele S.R., Steffens D., Stocchi L., Stylianides N.A., Tekkis P.P., Taylor C., Tsarkov P., Tsukamoto S., Turner W.H., Tuynman J.B., van Ramshorst G.H., van Zoggel D., Vasquez-Jimenez W., Verhoef C., Verstegen M., Wakeman C., Warrier S., Wasmuth H.H., Weiser M.R., Wheeler J.M.D., Wild J., Yip J., Winter D.C., Sammour T., Kroon, Hm, Dudi-Venkata, Nn, Bedrikovetski, S, Thomas, Ml, Kelly, Me, Aalbers, Agj, Abdul Aziz, N, Abraham-Nordling, M, Akiyoshi, T, Alberda, W, Andric, M, Antoniou, A, Austin, Kk, Baker, Rp, Bali, M, Baseckas, G, Bednarski, Bk, Beets, Gl, Berg, Pl, Beynon, J, Biondo, S, Bordeianou, L, Brunner, M, Buchwald, P, Burger, Jwa, Burling, D, Campain, N, Chan, Kkl, Chang, Gj, Chew, Mh, C Chong, P, Christensen, Hk, Codd, M, Colquhoun, Aj, Corr, A, Coscia, M, Coyne, Pe, Creavin, B, Damjanovic, L, Daniels, Ir, Davies, M, Davies, Rj, de Wilt, Jhw, Denost, Q, Dietz, D, Dozois, Ej, Duff, M, Eglinton, T, Enriquez-Navascues, Jm, Evans, Md, Fearnhead, N, Frizelle, Fa, Garcia-Granero, E, Garcia- Sabrido, Jl, Gentilini, L, George, Ml, Glynn, R, Golda, T, Griffiths, B, Harris, Da, Evans, M, Hagemans, Jaw, Harji, Dp, Heriot, Ag, Hohenberger, W, Holm, T, Jenkins, Jt, Kapur, S, Kanemitsu, Y, Kelley, Sr, Keller, D, Kim, H, Koh, Ce, Kok, Nfm, Kokelaar, R, Kontovounisios, C, Kusters, M, Larson, Dw, Law, Wl, Laurberg, S, Lee, P, Lydrup, Ml, Lynch, Ac, Mantyh, C, Mathis, Kl, Martling, A, Meijerink, Wjhj, Merkel, S, Mehta, Am, Mcdermott, Fd, Mcgrath, J, Mirnezami, A, Morton, Jr, Mullaney, Tg, Mesquita-Neto, Jw, Nielsen, Mb, Nieuwenhuijzen, Gap, Nilsson, Pj, O’Connell, Pr, Palmer, G, Patsouras, D, Pellino, G, Poggioli, G, Quinn, M, Quyn, A, Radwan, Rw, Rasheed, S, Rasmussen, Pc, Regenbogen, Se, Rocha, R, Rothbarth, J, Roxburgh, C, Rutten, Hjt, Ryan, E, Sagar, Pm, Saklani, A, Schizas, Amp, Schwarzkopf, E, Scripcariu, V, Shaikh, I, Shida, D, Simpson, A, Smart, Nj, Smith, Jj, Solomon, Mj, Sørensen, Mm, Steele, Sr, Steffens, D, Stocchi, L, Stylianides, Na, Tekkis, Pp, Taylor, C, Tsarkov, P, Tsukamoto, S, Turner, Wh, Tuynman, Jb, van Ramshorst, Gh, van Zoggel, D, Vasquez- Jimenez, W, Verhoef, C, Verstegen, M, Wakeman, C, Warrier, S, Wasmuth, Hh, Weiser, Mr, Wheeler, Jmd, Wild, J, Yip, J, Winter, Dc, and Sammour, T.

Subjects
medicine.medical_specialty, Pelvic Neoplasm, Palliative care, Fistula, medicine.medical_treatment, Disease, Locally advanced pelvic cancer, Tumours of the digestive tract Radboud Institute for Health Sciences [Radboudumc 14], 03 medical and health sciences, 0302 clinical medicine, SDG 3 - Good Health and Well-being, Quality of life, Internal medicine, Patient-Centered Care, Outcome Assessment, Health Care, medicine, Palliative surgery, Humans, Pelvic Neoplasms, Pelvic exenteration, business.industry, Mortality rate, Patient-centered outcomes, Palliative Care, General Medicine, medicine.disease, Pelvic Exenteration, Oncology, 030220 oncology & carcinogenesis, 030211 gastroenterology & hepatology, Surgery, business, Human
Abstract

Item does not contain fulltext OBJECTIVE: Palliative pelvic exenteration (PPE) is a technically complex operation with high morbidity and mortality rates, considered in patients with limited life expectancy. There is little evidence to guide practice. We performed a systematic review to evaluate the impact of PPE on symptom relief and quality of life (QoL). METHODS: A systematic review was conducted according to the PRISMA guidelines using Ovid MEDLINE, EMBASe, and PubMed databases for studies reporting on outcomes of PPE for symptom relief or QoL. Descriptive statistics were used on pooled patient cohorts. RESULTS: Twenty-three historical cohorts and case series were included, comprising 509 patients. No comparative studies were found. Most malignancies were of colorectal, gynaecological and urological origin. Common indications for PPE were pain, symptomatic fistula, bleeding, malodour, obstruction and pelvic sepsis. The pooled median postoperative morbidity rate was 53.6% (13-100%), the median in-hospital mortality was 6.3% (0-66.7%), and median OS was 14 months (4-40 months). Some symptom relief was reported in a median of 79% (50-100%) of the patients, although the magnitude of effect was poorly measured. Data for QoL measures were inconclusive. Five studies discouraged performing PPE in any patient, while 18 studies concluded that the procedure can be considered in highly selected patients. CONCLUSION: Available evidence on PPE is of low-quality. Morbidity and mortality rates are high with a short median OS interval. While some symptom relief may be afforded by this procedure, evidence for improvement in QoL is limited. A highly selective individualised approach is required to optimise the risk:benefit equation.

Published
2019
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7. Changing outcomes following pelvic exenteration for locally advanced and recurrent rectal cancer

Author

Kelly, M. E., Aalbers, A. G. J., Aziz, N. Abdul, Abraham-Nordling, M., Alberda, W., Antoniou, A., Austin, K. K., Baker, R., Bali, M., Baseckas, G., Bednarski, B. K., Beets, G. L., Berg, P. L., Beynon, J., Biondo, S., Bordeianou, L., Brunner, M., Buchwald, P., Burger, J. W. A., Burling, D., Campain, N., Chan, K. K. L., Chang, G., Chew, M. H., Chong, P. C., Christensen, H. K., Codd, M., Colquhoun, A. J., Corr, A., Coscia, M., Coyne, P. E., Creavin, B., Damjanovic, L., Daniels, I. R., Davies, M., Davies, R. J., de Wilt, J. H. W., Denost, Q., Deutsch, C., Dietz, D., Dozois, E. J., Duff, M., Eglinton, T., Evans, M., Evans, M. D., Fearnhead, N. S., Frizelle, F. A., Garcia-Granero, E., Garcia-Sabrido, J. L., Gentilini, L., George, M. L., Glynn, R., Golda, T., Griffiths, B., Hagemans, J. A. W., Harji, D. P., Harris, D. A., Heriot, A. A. G., Hohenberger, W., Holm, T., Jenkins, J. T., Kanemitsu, Y., Kapur, S., Keller, D. S., Kelley, S. R., Kim, H., Koh, C. E., Kok, N. F. M., Kokelaar, R., Kontovounisios, C., Kusters, M., Larson, D. W., Laurberg, S., Law, W. L., Lee, P., Lydrup, M. L., Lynch, A. C., Martling, A., Mathis, K. L., Meijerink, W. J. H. J., Mentha, A. M., Merkel, S., McDermott, F. D., McGrath, J. S., Mihailo, A., Mirnezami, A., Morton, J. R., Mullaney, T. G., Nielsen, M. B., Nieuwenhuijzen, G. A. P., Nilsson, P. J., O'Connell, P. R., Palmer, G., Patsouras, D., Pellino, G., Poggioli, G., Quinn, M., Quyn, A., Radwan, R. W., Rasheed, S., Rasmussen, P. C., Rocha, R., Rothbarth, J., Roxburgh, C., Rutten, H. J. T., Ryan, E., Sagar, P. M., Sammour, T., Schizas, A. M. P., Schwarzkopf, E., Scripcariu, V, Shaikh, I, Shida, D., Simpson, A., Smart, N. J., Smith, J., Solomon, M. J., Sorensen, M. M., Steele, S. R., Steffens, D., Stocchi, L., Stylianides, N. A., Taylor, C., Tekkis, P. P., Tsukamoto, S., Turner, W. H., Tuynman, J. B., van Ramshorst, Gabriëlle, van Zoggel, D., Vasquez-Jimenez, W., Verhoef, C., Verstegen, M., Wakeman, C., Warrier, S., Wasmuth, H. H., Weiser, M. R., Wheeler, J. M. D., Wild, J., Winter, D. C., Yip, J., Kelly, M. E., Aalbers, A. G. J., Aziz, N. Abdul, Abraham‐Nordling, M., Alberda, W., Antoniou, A., Austin, K. K., Baker, R., Bali, M., Baseckas, G., Bednarski, B. K., Beets, G. L., Berg, P. L., Beynon, J., Biondo, S., Bordeianou, L., Brunner, M., Buchwald, P., Burger, J. W. A., Burling, D., Campain, N., Chan, K. K. L., Chang, G., Chew, M. H., Chong, P. C., Christensen, H. K., Codd, M., Colquhoun, A. J., Corr, A., Coscia, M., Coyne, P. E., Creavin, B., Damjanovic, L., Daniels, I. R., Davies, M., Davies, R. J., Wilt, J. H. W., Denost, Q., Deutsch, C., Dietz, D., Dozois, E. J., Duff, M., Eglinton, T., Evans, M., Evans, M.D., Fearnhead, N. S., Frizelle, F. A., Garcia‐Granero, E., Garcia‐Sabrido, J. L., Gentilini, L., George, M. L., Glynn, R., Golda, T., Griffiths, B., Hagemans, J. A.W., Harji, D. P., Harris, D. A., Heriot, A. A. G., Hohenberger, W., Holm, T., Jenkins, J. T., Kanemitsu, Y., Kapur, S., Keller, D. S., Kelley, S. R., Kim, H., Koh, C. E., Kok, N. F. M., Kokelaar, R., Kontovounisios, C., Kusters, M., Larson, D. W., Laurberg, S., Law, W. L., Lee, P., Lydrup, M. L., Lynch, A. C., Martling, A., Mathis, K. L., Meijerink, W. J. H. J., Mentha, A. M., Merkel, S., McDermott, F. D., McGrath, J. S., Mihailo, A., Mirnezami, A., Morton, J. R., Mullaney, T. G., Nielsen, M. B., Nieuwenhuijzen, G. A. P., Nilsson, P. J., O'Connell, P. R., Palmer, G., Patsouras, D., Pellino, G., Poggioli, G., Quinn, M., Quyn, A., Radwan, R. W., Rasheed, S., Rasmussen, P. C., Rocha, R., Rothbarth, J., Roxburgh, C., Rutten, H. J. T., Ryan, É., Sagar, P. M., Sammour, T., Schizas, A. M. P., Schwarzkopf, E., Scripcariu, V., Shaikh, I., Shida, D., Simpson, A., Smart, N. J., Smith, J., Solomon, M. J., Sørensen, M.M., Steele, S. R., Steffens, D., Stocchi, L., Stylianides, N. A., Taylor, C., Tekkis, P. P., Tsukamoto, S., Turner, W. H., Tuynman, J. B., Ramshorst, G. H., Zoggel, D., Vasquez‐Jimenez, W., Verhoef, C., Verstegen, M., Wakeman, C., Warrier, S., Wasmuth, H. H., Weiser, M. R., Wheeler, J. M. D., Wild, J., Winter, D. C., Yip, J., Kelly, Me, Aalbers, Agj, Aziz, Na, Abraham-Nordling, M, Alberda, W, Antoniou, A, Austin, Kk, Baker, R, Bali, M, Baseckas, G, Bednarski, Bk, Beets, Gl, Berg, Pl, Beynon, J, Biondo, S, Bordeianou, L, Brunner, M, Buchwald, P, Burger, Jwa, Burling, D, Campain, N, Chan, Kkl, Chang, G, Chew, Mh, Chong, Pc, Christensen, Hk, Codd, M, Colquhoun, Aj, Corr, A, Coscia, M, Coyne, Pe, Creavin, B, Damjanovic, L, Daniels, Ir, Davies, M, Davies, Rj, de Wilt, Jhw, Denost, Q, Deutsch, C, Dietz, D, Dozois, Ej, Duff, M, Eglinton, T, Evans, M, Evans, Md, Fearnhead, N, Frizelle, Fa, Garcia-Granero, E, Garcia-Sabrido, Jl, Gentilini, L, George, Ml, Glynn, R, Golda, T, Griffiths, B, Hagemans, Jaw, Harji, Dp, Harris, Da, Heriot, Aag, Hohenberger, W, Holm, T, Jenkins, Jt, Kanemitsu, Y, Kapur, S, Keller, D, Kelley, Sr, Kim, H, Koh, Ce, Kok, Nfm, Kokelaar, R, Kontovounisios, C, Kusters, M, Larson, Dw, Laurberg, S, Law, Wl, Lee, P, Lydrup, Ml, Lynch, Ac, Martling, A, Mathis, Kl, Meijerink, Wjhj, Mentha, Am, Merkel, S, Mcdermott, Fd, Mcgrath, J, Mihailo, A, Mirnezami, A, Morton, Jr, Mullaney, Tg, Nielsen, Mb, Nieuwenhuijzen, Gap, Nilsson, Pj, O'Connell, Pr, Palmer, G, Patsouras, D, Pellino, G, Poggioli, G, Quinn, M, Quyn, A, Radwan, Rw, Rasheed, S, Rasmussen, Pc, Rocha, R, Rothbarth, J, Roxburgh, C, Rutten, Hjt, Ryan, E, Sagar, Pm, Sammour, T, Schizas, Amp, Schwarzkopf, E, Scripcariu, V, Shaikh, I, Shida, D, Simpson, A, Smart, Nj, Smith, J, Solomon, Mj, Sorensen, Mm, Steele, Sr, Steffens, D, Stocchi, L, Stylianides, Na, Taylor, C, Tekkis, Pp, Tsukamoto, S, Turner, Wh, Tuynman, Jb, van Ramshorst, Gh, van Zoggel, D, Vasquez-Jimenez, W, Verhoef, C, Verstegen, M, Wakeman, C, Warrier, S, Wasmuth, Hh, Weiser, Mr, Wheeler, Jmd, Wild, J, Winter, Dc, and Yip, J

Subjects
Male, Blood transfusion, Colorectal cancer, medicine.medical_treatment, Surgical Flaps, COLORECTAL-CANCER, Tumours of the digestive tract Radboud Institute for Health Sciences [Radboudumc 14], Postoperative Complications, Retrospective Studie, Medicine and Health Sciences, Mortality rate, General Medicine, Middle Aged, Treatment Outcome, medicine.anatomical_structure, HOSPITAL VOLUME, SURVIVAL, Original Article, Female, Life Sciences & Biomedicine, Human, medicine.medical_specialty, lcsh:Surgery, Rectum, Subgroup analysis, SDG 3 - Good Health and Well-being, medicine, Humans, Blood Transfusion, Retrospective Studies, Aged, Science & Technology, Pelvic exenteration, Rectal Neoplasms, business.industry, MORTALITY, PelvEx Collaborative, Retrospective cohort study, Original Articles, lcsh:RD1-811, Length of Stay, medicine.disease, SURGEON VOLUME, Pelvic Exenteration, Surgery, Surgical Flap, Postoperative Complication, Neoplasm Recurrence, Local, business, Complication
Abstract

Contains fulltext : 215764.pdf (Publisher’s version ) (Open Access) Background: Pelvic exenteration for locally advanced rectal cancer (LARC) and locally recurrent rectal cancer (LRRC) is technically challenging but increasingly performed in specialist centres. The aim of this study was to compare outcomes of exenteration over time. Methods: This was a multicentre retrospective study of patients who underwent exenteration for LARC and LRRC between 2004 and 2015. Surgical outcomes, including rate of bone resection, flap reconstruction, margin status and transfusion rates, were examined. Outcomes between higher- and lower-volume centres were also evaluated. Results: Some 2472 patients underwent pelvic exenteration for LARC and LRRC across 26 institutions. For LARC, rates of bone resection or flap reconstruction increased from 2004 to 2015, from 3.5 to 12.8 per cent, and from 12.0 to 29.4 per cent respectively. Fewer units of intraoperative blood were transfused over this interval (median 4 to 2 units; P = 0.040). Subgroup analysis showed that bone resection and flap reconstruction rates increased in lower- and higher-volume centres. R0 resection rates significantly increased in low-volume centres but not in high-volume centres over time (low-volume: from 62.5 to 80.0 per cent, P = 0.001; high-volume: from 83.5 to 88.4 per cent, P = 0.660). For LRRC, no significant trends over time were observed for bone resection or flap reconstruction rates. The median number of units of intraoperative blood transfused decreased from 5 to 2.5 units (P < 0.001). R0 resection rates did not increase in either low-volume (from 51.7 to 60.4 per cent; P = 0.610) or higher-volume (from 48.6 to 65.5 per cent; P = 0.100) centres. No significant differences in length of hospital stay, 30-day complication, reintervention or mortality rates were observed over time. Conclusion: Radical resection, bone resection and flap reconstruction rates were performed more frequently over time, while transfusion requirements decreased.

Published
2019

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