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Systematic review of outcomes following pelvic exenteration for the treatment of primary and recurrent locally advanced rectal cancer

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Abstract

Background

Pelvic exenteration represents the best treatment option for cure of locally advanced or recurrent rectal cancer. This systematic review sought to evaluate current literature regarding short and long term treatment outcomes and long term survival following pelvic exenteration.

Methods

A systematic search of the MEDLINE, PubMed and Ovid databases was conducted to identify suitable articles published between 2001 and 2016. The article search was performed in line with Cochrane methodology and reported according to the Preferred Reporting Items for Systematic reviews and Meta-analyses statement.

Results

Sixteen studies were included in the final analysis, incorporating 1016 patients. Sixty-three percent of patients were male and median patient age was 59 years. Median operating time was 7.2 h with median blood loss of 1.9 l. Median postoperative stay was 17 days with a median 30-day mortality of 0. Complication rates were 31.6–86% with a return to theatre rate of 14.6%. Median R0 resection rate was 74% and was higher for primary cancer (82.6% versus 58% for recurrent cancer). Mean overall survival was 31 months and median 5-year survival was 32%. Recurrently identified indicators of adverse outcome included R1/2 resection, preoperative pelvic pain and previous abdominoperineal resection of the rectum.

Conclusions

Pelvic exenteration remains a major operation associated with significant morbidity and mortality. Despite advances in preoperative assessment and staging, R1 resection rates remain high. There is also a high degree of variability of reporting outcomes and standardisation of this process would aid comparison of results between centres and drive forward research in this area.

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Funding

No grant support or financial relationship, no funding received.

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Author notes

  1. Parts of manuscript presented as a poster at European Society of Coloproctology, Berlin, Germany, 20–22nd September 2017.

Authors and Affiliations

  1. Colorectal Unit, Derriford Hospital, Plymouth Hospital NHS Trust, Plymouth, UK

    E. Platt, G. Dovell & S. Smolarek

Authors
  1. E. Platt
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  2. G. Dovell
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  3. S. Smolarek
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Contributions

EP—data acquisition/analysis, drafting the work, final approval and agreement to be accountable. GD—data acquisition/analysis, final approval and agreement to be accountable. SS—data analysis, critical revision of work, final approval and agreement to be accountable.

Corresponding author

Correspondence to E. Platt.

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The authors declare they have no conflict of interest.

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This study does not contain any studies with human participants or animals performed by any of the authors.

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Platt, E., Dovell, G. & Smolarek, S. Systematic review of outcomes following pelvic exenteration for the treatment of primary and recurrent locally advanced rectal cancer. Tech Coloproctol 22, 835–845 (2018). https://doi.org/10.1007/s10151-018-1883-1

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  • DOI: https://doi.org/10.1007/s10151-018-1883-1

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