Karpenko, M. O., Shostka, K. G., Zagainov, E. V., Shilyaev, A. V., & Kalinin, I. V. (2024). Surgical Management of Locally Advanced Colorectal Cancer. Voprosy Onkologii, 70(1), 105–112. https://doi.org/10.37469/0507-3758-2024-70-1-105-112

Abstract

Introduction. The article presents the evaluation of perioperative results of pelvic exenteration (PE) in patients with primary locally advanced and locally recurrent colorectal cancer.

Materials and Methods. From 2005 to 2022, 206 operations were performed in Leningrad Regional Clinical Oncological Dispensary named after L.D. Roman. The mean age of the patients was 61 years, with 168 (82 %) females and 38 (18 %) males. The following types of PE were performed: supralevator total exenteration with anastomosis — 28 (13.6 %), supralevator total exenteration without anastomosis — 14 (6.8 %), infralevator total exenteration — 20 (9.7 %), anterior exenteration with vaginal resection — 1 (0.5 %), supralevator posterior exenteration with anastomosis — 65 (31.6 %), supralevator obstructive posterior exenteration — 48 (23.3 %), infralevator posterior exenteration — 30 (14.5 %).

Results. 106 (51.5 %) patients developed postoperative complications. The mortality rate was 8.7 %. Overall survival (OS) in the R0 resection subgroup was the following: 3-year OS was 56.5 % (95 % CI 48.3-66.2) and 5-year OS was 47.3 % (95 % CI 38.5-58.1). There was a statistically significant difference in the 5-year OS between patients with R0 or R1/R2 resection (p = 0.01). Median survival was 26 months for R0 group, and 11 months for R1/R2 groups.

Conclusion. The most important prognostic factor for assessing OS is the achievement of R0 resection. The nature of the tumor did not affect the long-term survival. PE should be performed in centers with appropriate experience.

https://doi.org/10.37469/0507-3758-2024-70-1-105-112

##article.numberofdownloads## 95

##article.numberofviews## 206

pdf (Русский)

References

Sung H., Ferlay J., Siegel R.L., et al. Global Cancer Statistics 2020: GLOBOCAN estimates of incidence and mortality worldwide for 36 cancers in 185 countries. CA Cancer J Clin. 2021; 71(3): 209-249.-DOI: https://doi.org/ 10.3322/caac.21660.

Под ред. А.Д. Каприна, В.В. Старинского, А.О. Шахзадовой. – М.: МНИОИ им. П.А. Герцена − филиал ФГБУ «НМИЦ радиологии» Минздрава России. 2022; илл. 252 с.-ISBN: 978-5-85502-280-3. [Malignant neoplasms in Russia in 2021 (morbidity and mortality). Ed. by Kaprin A.D., Starinskiy V.V., Shakhzadova A.O., eds. Moscow: National Medical Research Radiological Centre of the Ministry of Health of the Russian Federation. 2022; ill:252.-ISBN: 978-5-85502-280-3. (In Rus)].

Zeng W., Liu Y., Wang C., et al. Efficacy and safety of neoadjuvant chemotherapy combined with adjuvant chemotherapy for locally advanced colon cancer: a propensity score-matching analysis. Medicina (Kaunas). 2022; 58(11): 1505.-DOI: https://doi.org/ 10.3322/caac.21660.

van Kessel C.S., Solomon M.J. Understanding the philosophy, anatomy, and surgery of the extra-tme plane of locally advanced and locally recurrent rectal cancer; single institution experience with international benchmarking. Cancers (Basel). 2022; 14(20): 5058.-DOI: https://doi.org/ 10.3390/cancers14205058.

Gosavi R., Chia C., Michael M., et al. Neoadjuvant chemotherapy in locally advanced colon cancer: a systematic review and meta-analysis. Int J Colorectal Dis. 2021; 36(10): 2063-2070.-DOI: https://doi.org/10.1007/s00384-021-03945-3.

Kumar N.A., Desouza A., Ostwal V., et al. Outcomes of exenteration in cT4 and fixed cT3 stage primary rectal adenocarcinoma: a subgroup analysis of consolidation chemotherapy following neoadjuvant concurrent chemoradiotherapy. Langenbecks Arch Surg. 2021; 406(3): 821-831.-DOI: https://doi.org /10.1007/s00423-021-02143-7.

Kelly M.E., Aalbers A.G.J., Aziz N.A., et al. Changing outcomes following pelvic exenteration for locally advanced and recurrent rectal cancer. BJS Open. 2019; 3(4): 516-20.-DOI: http://dx.doi.org/10.1002/bjs5.50153.

Lopez M.J., Barrios L. Evolution of pelvic exenteration. Surg Oncol Clin N Am. 2005; 14(3): 587-606, vii.-DOI: https://doi.org /10.1016/j.soc.2005.05.005.

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(2): 177-83.-DOI: https://doi.org/10.1002/1097-0142(194807)1:2<177::aid cncr2820010203>3.0.co;2-a.

Appleby L.H., Deddish M.R. Discussion on the treatment of advanced cancer of the rectum. Proc R Soc Med. 1950; 43(12): 1071-81.

Koh C.E., Brown K.G.M., Steffens D. et al. What constitutes a clear margin in patients with locally recurrent rectal cancer undergoing pelvic exenteration? Ann Surg. 2022; 275(1): 157-165.-DOI: https://doi.org /10.1097/SLA.0000000000003834.

Koh C.E., Solomon M.J., Brown K.G., et al. The evolution of pelvic exenteration practice at a single center: lessons learned from over 500 cases. Dis Colon Rectum. 2017; 60(6): 627-35.-DOI: http://dx.doi.org/10.1097/dcr.0000000000000825.

Brown K.G.M., Solomon M.J., Koh C.E. Pelvic exenteration surgery: the evolution of radical surgical techniques for advanced and recurrent pelvic malignancy. Dis Colon Rectum. 2017; 60(7): 745-754.-DOI: https://doi.org /10.1097/DCR.0000000000000839.

PelvEx Collaborative. Contemporary management of locally advanced and recurrent rectal cancer: views from the pelvex collaborative. Cancers (Basel). 2022; 14(5): 1161.-DOI: https://doi.org/10.3390/cancers14051161.

Bayer A., Heinze T., Alkatout I., et al. Embryological development and topographic anatomy of pelvic compartments-surgical relevance for pelvic lymphonodectomy. J Clin Med. 2021; 10(4): 708.-DOI: https://doi.org/10.3390/jcm10040708.

Kajmolli A., McGuirk M., Gachabayov M., et al. Evolution of the circular stapler in rectal cancer surgery. Surg Technol Int. 2020; 37: 99-101.

Doyle D.J., Hendrix J.M., Garmon E.H. American Society of Anesthesiologists Classification. [Updated 2023 Aug 17]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2023. URL: https://www.ncbi.nlm.nih.gov/books/NBK441940/.

Pawlik T.M., Skibber J.M., Rodriguez-Bigas M.A. Pelvic exenteration for advanced pelvic malignancies. Ann Surg Oncol. 2006; 13(5): 612-23.-DOI: https://doi.org/10.1245/ASO.2006.03.082.

Ishizaki H., Nakashima S., Hamada T., et al. Laparoscopic anterior pelvic exenteration for locoregionally advanced rectal cancer directly invading the urinary bladder: A case report of low anterior resection with en bloc cystectomy for sphincter preservation. Asian J Endosc Surg. 2015; 8(3): 343-6.-DOI: http://dx.doi.org/10.1111/ases.12196.

FOxTROT Collaborative Group. Feasibility of preoperative chemotherapy for locally advanced, operable colon cancer: the pilot phase of a randomised controlled trial. Lancet Oncol. 2012; 13(11): 1152-60.-DOI: https://doi.org/10.1016/S1470-2045(12)70348-0.

Phillips R.K., Hittenger R., Blesovsky L., et al. Local recurrence following 'curative' surgery for large bowel cancer: I. The overall picture. Br J Surg. 1984; 71(1): 12-6.-DOI: https://doi.org/10.1002/bjs.1800710104.

Heald R.J., Husband E.M., Ryall R.D. The mesorectum in rectal cancer surgery--the clue to pelvic recurrence? Br J Surg. 1982; 69(10): 613-6.-DOI: https://doi.org/10.1002/bjs.1800691019.

Ito K., Kato T., Tadokoro M., et al. Recurrent rectal cancer and scar: differentiation with PET and MR imaging. Radiology. 1992; 182(2): 549-52.-DOI: https://doi.org/10.1148/radiology.

Ishiguro S., Akasu T., Fujita S., et al. Pelvic exenteration for clinical T4 rectal cancer: Oncologic outcome in 93 patients at a single institution over a 30-year period. Surgery. 2009; 145(2): 189-95.-DOI: https://doi.org/10.1016/j.surg.2008.09.014.

Bogner A., Fritzmann J., Müssle B., et al. Pelvic exenteration for colorectal and non-colorectal cancer: a comparison of perioperative and oncological outcome. Int J Colorectal Dis. 2021; 36(8): 1701-1710.-DOI: https://doi.org/10.1007/s00384-021-03893-y.

Yang H.Y., Park S.C., Hyun J.H., et al. Outcomes of pelvic exenteration for recurrent or primary locally advanced colorectal cancer. Ann Surg Treat Res. 2015; 89(3): 131-7.-DOI: https://doi.org/10.4174/astr.2015.89.3.131.

Ермакова А.В., Балюра О.В., Гребеньков В.Г. Выполнение эвисцераций малого таза как метод лечения местнораспространенных рецидивных опухолей. Известия. 2022; 41(S2): 150-153. [Ermakova A.V., Balura O.V., Grebenkov V.G. Performing pelvic eviscerations as a method of treating locally advanced recurrent tumors. Izvestia= The News. 2022; 41(S2): 150-153. (In Rus)].

Шостка К.Г., Павленко А.Н., Роман Л.Д., и др. Технические аспекты и результаты выполнения эвисцераций малого таза при колоректальном раке. Онкология. Журнал им. ПА Герцена. 2015; 4(2): 41-45. [Shostka K.G., Pavlenko A.N., Roman L.D., et al. Technical aspects and results of pelvic evisceration in colorectal cancer. P.A. Herzen Journal of Oncology. 2015; 4(2): 41-45. (In Rus).].

Quyn A.J., Austin K.K., Young J.M., et al. Outcomes of pelvic exenteration for locally advanced primary rectal cancer: Overall survival and quality of life. Eur J Surg Oncol. 2016; 42(6): 823-8.-DOI: https://doi.org/10.1016/j.ejso.2016.02.016.

Kazi M., Desouza A., Nashikkar C., et al. Minimally invasive surgery for maximally invasive tumors: pelvic exenterations for rectal cancers. J Minim Invasive Surg. 2022; 25(4): 131-138.-DOI: https://doi.org/10.7602/jmis.2022.25.4.131.

Tang J.Q., Zhang J.Z., Mei S.W., et al. [Laparoscopic versus open pelvic exenteration for locally advanced rectal cancer: analysis of short- and long-term effects (In Chin)]. Zhonghua Wei Chang Wai Ke Za Zhi. 2023; 26(3): 253-259.-DOI: https://doi.org/10.3760/cma.j.cn441530-20230222-00049.

Ryan O.K., Doogan K.L., Ryan É.J., et al. Comparing minimally invasive surgical and open approaches to pelvic exenteration for locally advanced or recurrent pelvic malignancies - Systematic review and meta-analysis. Eur J Surg Oncol. 2023: S0748-7983(23)00440-7.-DOI: https://doi.org/10.1016/j.ejso.2023.04.003.

Casey L., Larach J.T., Waters P.S., et al. Application of minimally invasive approaches to pelvic exenteration for locally advanced and locally recurrent pelvic malignancy - A narrative review of outcomes in an evolving field. Eur J Surg Oncol. 2022; 48(11): 2330-2337.-DOI: https://doi.org/10.1016/j.ejso.2022.08.004.

PelvEx Collaborative. Surgical and Survival Outcomes Following Pelvic Exenteration for Locally Advanced Primary Rectal Cancer: Results From an International Collaboration. Ann Surg. 2019; 269(2): 315-321.-DOI: https://doi.org/10.1097/SLA.0000000000002528.

Kazi M., Kumar N.A.N., Rohila J., et al. Minimally invasive versus open pelvic exenterations for rectal cancer: a comparative analysis of perioperative and 3-year oncological outcomes. BJS Open. 2021; 5(5): zrab074.-DOI: https://doi.org/10.1016/10.1093/bjsopen/zrab074.

This work is licensed under a Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License.