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Annals of Surgery:
doi: 10.1097/SLA.0b013e31828a0d22
Original Articles

Indications and Outcome of Pelvic Exenteration for Locally Advanced Primary and Recurrent Rectal Cancer

Bhangu, Aneel MBChB, MRCS*,†; Mohammed Ali, S. MBBS, MRCS*,†; Brown, Gina MBBS, FRCR; Nicholls, R. John MChir, FRCS§; Tekkis, Paris MD, FRCS*,†

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Abstract

Objective: The outcome of pelvic exenteration was compared in patients with locally advanced primary (LAP) cancer and recurrent rectal cancer (RRC).

Background: There are few reports comparing the results of pelvic exenteration for primary advanced rectal cancer and RRC.

Methods: Consecutive patients undergoing pelvic exenteration between 2006 and 2011 were identified from a prospectively maintained database. The main endpoints were 3-year disease-free survival (DFS) and local recurrence-free survival (LRFS).

Results: Of 100 exenterative operations, 55 were for LAP cancer and 45 for RRC. Exenteration of 1 pelvic compartment was required in 30 cases, 2 compartments in 49 cases, and 3 of 4 compartments in 21 cases. R0, R1, and R2 resections were achieved in 78, 15, and 7 cases, respectively. R0 rates were significantly higher in LAP cancer than in RRC (91% vs 62%, P = 0.001). Three-year DFS for R0, R1, and R2 resections was 67%, 49%, and 0%, respectively (P < 0.001). For R0 resections only, DFS in LAP cancer was 76% and 57% in RRC (P = 0.212). On multivariate analysis, a positive resection margin (hazard ratio, 4.04; P < 0.001) and positive lymph node staging (hazard ratio, 2.43; P = 0.022) were significant predictors of reduced DFS. Three-year LRFS for R0 resection was 86% for LAP cancer and 84% for RRC (P = 0.817). On multivariate analysis, only a positive resection margin was a significant predictor of reduced LRFS (hazard ratio, 5.48; P = 0.002).

Conclusions: Resection margin status is more important than primary or recurrent cancer in predicting long-term outcome.

© 2014 by Lippincott Williams & Wilkins.

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