100 small pelvic exenterations in patients with locally advanced primary and recurrent rectal tumors

Sidorov D.V.

Moskovskiĭ nauchno-issledovatel'skiĭ onkologicheskiĭ institut im. P.A. Gertsena Rosmedtekhnologiĭ, Moskva

ORCID: 0000-0002-8282-9351

Alekseev B.Ia.

FGBU "Moskovskiĭ nauchno-issledovatel'skiĭ onkologicheskiĭ institut im. P.A. Gertsena" Minzdrava Rossii

Lozhkin M.V.

Moskovskiĭ nauchno-issledovatel'skiĭ onkologicheskiĭ institut im. P.A. Gertsena Rosmedtekhnologiĭ, Moskva

ORCID: 0000-0003-1125-1131

Vorob'ev N.V.

FGBU "Moskovskiĭ nauchno-issledovatel'skiĭ onkologicheskiĭ institut im P.A. Gertsena"

Petrov L.O.

Herzen Moscow Oncology Research Institute of Healthcare Ministry of the Russian Federation — branch of National Medical Research Radiology Center

ORCID: 0000-0001-6272-9647

Grishin N.A.

Moskovskiĭ nauchno-issledovatel'skiĭ onkologicheskiĭ institut im. P.A. Gertsena Rosmedtekhnologiĭ, Moskva

Troitskiĭ A.A.

Moskovskiĭ nauchno-issledovatel'skiĭ onkologicheskiĭ institut im. P.A. Gertsena Rosmedtekhnologiĭ, Moskva

Korolev P.A.

Institut khirurgii im. A.V. Vishnevskogo, Moskva

Moshurov R.I.

P.A. Herzen Moscow Oncology Research Institute, Branch, National Medical Radiology Research Center, Ministry of Health of Russia, Moscow, Russia

100 small pelvic exenterations in patients with locally advanced primary and recurrent rectal tumors

Authors:

Sidorov D.V., Alekseev B.Ia., Lozhkin M.V., Vorob'ev N.V., Petrov L.O., Grishin N.A., Troitskiĭ A.A., Korolev P.A., Moshurov R.I.

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Journal: P.A. Herzen Journal of Oncology. 2017;6(2): 5‑11

DOI: 10.17116/onkolog2017625-11

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To cite this article:

Sidorov DV, Alekseev BIa, Lozhkin MV, et al. . 100 small pelvic exenterations in patients with locally advanced primary and recurrent rectal tumors. P.A. Herzen Journal of Oncology. 2017;6(2):5‑11. (In Russ.)
https://doi.org/10.17116/onkolog2017625-11

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Objective: to analyze the results of small pelvic exenterations in patients with locally advanced and recurrent rectal tumors. Subjects and methods. 100 small pelvic exenterations for locally advanced rectal tumors were carried out in 2005 to 2016. Total small pelvic exenteration was performed in 36 patients (11 women, 25 men), posterior exenteration was done in 64. Results. Planned morphological study of distant specimens showed that R0 resections could be performed in 75 cases. Twenty-nine patients developed postoperative complications that required surgical correction in 4 patients. One-year tumor-specific survival was 93.2% (95% CI, 84.2—99.5), three-year survival was 65.1% (95% CI, 38.6—67.5), and five-year survival was 32.4% (95% CI, 9.1—54.2). The long-term results correlated with the radicalism of the intervention performed and with the type (primary or recurrent) of a tumor, rather than the volume of exenteration. Conclusion. Small pelvic exenterations for locally advanced recurrent rectal tumors allow one to expect radical tumor removal and, as a consequence, satisfactory long-term results in this extremely difficult group of patients.

Keywords:

locally advanced primary rectal tumors

recurrent rectal tumors

small pelvic exenteration

Authors:

Sidorov D.V.

Moskovskiĭ nauchno-issledovatel'skiĭ onkologicheskiĭ institut im. P.A. Gertsena Rosmedtekhnologiĭ, Moskva

ORCID: 0000-0002-8282-9351

Alekseev B.Ia.

FGBU "Moskovskiĭ nauchno-issledovatel'skiĭ onkologicheskiĭ institut im. P.A. Gertsena" Minzdrava Rossii

Lozhkin M.V.

Moskovskiĭ nauchno-issledovatel'skiĭ onkologicheskiĭ institut im. P.A. Gertsena Rosmedtekhnologiĭ, Moskva

ORCID: 0000-0003-1125-1131

Vorob'ev N.V.

FGBU "Moskovskiĭ nauchno-issledovatel'skiĭ onkologicheskiĭ institut im P.A. Gertsena"

Petrov L.O.

Herzen Moscow Oncology Research Institute of Healthcare Ministry of the Russian Federation — branch of National Medical Research Radiology Center

ORCID: 0000-0001-6272-9647

Grishin N.A.

Moskovskiĭ nauchno-issledovatel'skiĭ onkologicheskiĭ institut im. P.A. Gertsena Rosmedtekhnologiĭ, Moskva

Troitskiĭ A.A.

Moskovskiĭ nauchno-issledovatel'skiĭ onkologicheskiĭ institut im. P.A. Gertsena Rosmedtekhnologiĭ, Moskva

Korolev P.A.

Institut khirurgii im. A.V. Vishnevskogo, Moskva

Moshurov R.I.

P.A. Herzen Moscow Oncology Research Institute, Branch, National Medical Radiology Research Center, Ministry of Health of Russia, Moscow, Russia

List of references:

Heald RJ, Ryall RD. Recurrence and survival after total mesorectal excision for rectal cancer. Lancet. 1986;1(8496):1479-1482.
Fisher B, Wolmark N, Rockette H, Redmond C, Deutsch M, Wickerham DL, et al. Postoperative adjuvant chemotherapy or radiation therapy for rectal cancer: results from NSABP protocol R-01. J Natl Cancer Inst. 1988;80(1):21-29.
Gérard A, Buyse M, Nordlinger B, Loygue J, Pène F, Kempf P, et al. Preoperative radiotherapy as adjuvant treatment in rectal cancer. Final results of a randomized study of the European Organization for Research and Treatment of Cancer (EORTC). Ann Surg. 1988;208(5):606-614.
Påhlman L, Glimelius B. Local recurrences after surgical treatment for rectal carcinoma. Acta Chir Scand. 1984;150(4):331-335.
Fedorov VD, Vorob'ev GI, Rivkin VL. Clinical operational proctology [Klinicheskaya operativnaya koloproktologiya]. Moscow: GNTs proktologii; 1994. (In Russ.)
Krivokapic Z, Barisic G, Markovic V, Popovic M, Antic S, Jovanovic D, Protic S. First thousand rectal cancer cases—local recurrence and survival. Acta Chir Iugosl. 2004;51(2):133-137.
Mahteme H, Påhlman L. Good colorectal cancer surgery. Tech Coloproctol. 2005;9(1):1-7.
Rahbari NN, Ulrich AB, Bruckner T, Münter 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(3):522-533.
den Dulk M, Marijnen CA, Putter H, Rutten HJ, Beets GL, Wiggers T, et al. Risk factors for adverse outcome in patients with rectal cancer treated with an abdominoperineal resection in the total mesorectal excision trial. Ann Surg. 2007;246(1):83-90.
Nagtegaal ID, Quirke P. What is the role for the circumferential margin in the modern treatment of rectal cancer? J Clin Oncol. 2008;26(2):303-312.
Solomon M, Austin K, Lee P, Holm T, Rasmussen PC. Treatment of local recurrence of rectal cancer. Ugeskr Laeger. 2011;173(14):1047-1049.
Lindsetmo RO, Joh YG, Delaney CP. Surgical treatment for rectal cancer: An international perspective on what the medical gastroenterologist needs to know. World J Gastroenterol. 2008;14(21):3281-3289.
Chissov VI, Starinskii VV, Petrova GV, eds. Malignancies in Russia in 2005 (morbidity and mortality) [Zlokachestvennye novoobrazovaniya v Rossii v 2005 (zabolevaemost' i smertnost')]. Moscow; 2007. (In Russ.)
Secco GB, Fardelli R, Rovida S, Gianquinto D, Baldi E, Bonfante P, et al. Is intensive follow-up really able to improve prognosis of patients with local recurrence after curative surgery for rectal cancer? Ann Surg Oncol. 2000;7(1):32-37.
Brunschwig A. Complete excision of pelvic viscera in the male for advanced carcinoma of the sigmoid invading the urinary bladder. Ann Surg. 1949;129(4):499-504.
Brunschwig A, Daniel W. Pelvic exenteration operations: With summary of 66 cases surviving more then 5 years. Ann Surg. 1960;151:571-576.
Brunschwig A, Daniel W. Total and anterior pelvic exenteration. Report of results based upon 315 operations. Surg Gynecol Obstet. 1954;99(3):324-330.
Shirokopad VI. Surgical treatment of locally advanced tumors of the pelvic organs [Khirurgicheskoe lechenie mestno-rasprostranennykh opukholei organov malogo taza]. Moscow: Meditsina; 2008. (In Russ.)
Russo P, Ravindran B, Katz J, Paty P, Guillem J, Cohen AM. Urinary diversion after total pelvic exenteration for rectal cancer. Ann Surg Oncol. 1999;6(8):732-738.
Ferenschild FT, Vermaas M, Verhoef C, Ansink AC, Kirkels WJ, Eggermont AM, de Wilt JH. Total pelvic exenteration for primary and recurrent malignancies. World J Surg. 2009;33(7):1502-1508.
Ali AT, Clagett GP, Edwards MJ. Complex venous and arterial reconstruction with deep vein after pelvic exenterative surgery: a case report. Am Surg. 2006;72(1):22-24.
Belov Yu V, Skipenko OG, Zavenyan ZS, Makeev Yu M, Troitskii AA, Tulina IA, Tsar'kov PV. Resection and prosthetics of abdominal aorta when you remove the sigmoid colon cancer metastasis in the para-aortic lymph nodes. Khirurgiya. Zhurnal imeni N.I. Pirogova. 2007;(3):54-57. (In Russ.)
Kido A, Koyama F, Akahane M, Koizumi M, Honoki K, Nakajima Y, Tanaka Y. Extent and contraindications for sacral amputation in patients with recurrent rectal cancer: a systematic literature review. J Orthop Sci. 2011;16(3):286-290.
Melton GB, Paty PB, Boland PJ, Healey JH, Savatta SG, Casas-Ganem JE, et al. Sacral resection for recurrent rectal cancer: analysis of morbidity and treatment results. Dis Colon Rectum. 2006;49(8):1099-1107.
Pruthi RS, Stefaniak H, Hubbard JS, Wallen EM. Robot-assisted laparoscopic anterior pelvic exenteration for bladder cancer in the female patient. J Endourol. 2008;22(10):2397-2402; discussion 2402.
Skrovina M, Stursa M, Czudek S, Bartos J, Soumarová R, Adamcík L. Laparoscopy-assisted exenteration of the pelvis in a locally advanced rectal carcinoma. Rozhl Chir. 2006;85(3):129-133.
Puntambekar S, Kudchadkar RJ, Gurjar AM, Sathe RM, Chaudhari YC, Agarwal GA, Rayate NV. Laparoscopic pelvic exenteration for advanced pelvic cancers: a review of 16 cases. Gynecol Oncol. 2006;102(3):513-516.
Kyriazi MA, Stafyla VK, Kondi-Pafiti A, Arkadopoulos N, Dafnios N, Hasiakos D, et al. A novel technique for surgical reconstruction of the perineal floor following anteroposterior exenteration of the pelvis—case report and review of the literature. Eur J Gynaecol Oncol. 2010;31(2):201-205.
Stechl NM, Baumeister S, Grimm K, Kraus TW, Bockhorn H, Exner KE. Microsurgical reconstruction of the pelvic floor after pelvic exenteration. Reduced morbidity and improved quality of life by an interdisciplinary concept. Chirurg. 2011;82(7):625-630.
Ikenaga M, Miyazaki M, Yasui M, Mishima H, Tsujie M, Miyamoto A, et al. A case of total pelvic exenteration and reconstruction of perianal skin defect using a VY advancement of bilateral gluteus maximus musculocutaneous flaps for anal canal cancer associated with anal fistula. Gan To Kagaku Ryoho. 2010;37(12):2650-2652.
Gannon CJ, Zager JS, Chang GJ, Feig BW, Wood CG, Skibber JM, Rodriguez-Bigas MA. Pelvic exenteration affords safe and durable treatment for locally advanced rectal carcinoma. Ann Surg Oncol. 2007;14(6):1870-1877.
Nielsen M, Rasmussen P, Lindegaard J, 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(9):1076-1083. doi:10.1111/j.1463-1318.2011.02893.x
Jiang Y, Wan YL, Liu YC, Wang X, Pan YS, Wu T, et al. Surgical outcomes for 187 patients with locally recurrent rectal cancer and analysis of prognostic factors. Zhonghua Wei Chang Wai Ke Za Zhi. 2011;14(8):582-585.
Wydra D, Emerich J, Sawicki S, Ciach K, Marciniak A. Major complications following exenteration in cases of pelvic malignancy: a 10-year experience. World J Gastroenterol. 2006;12(7):1115-1119.
Moriya Y, Akasu T, Fujita S, Yamamoto S. Total pelvic exenteration with distal sacrectomy for fixed recurrent rectal cancer in the pelvis. Dis Colon Rectum. 2004;47(12):2047-2053;discussion 2053-2054.
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(51):700-703.
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(2):189-195.
Ike H, Shimada H, Yamaguchi S, Ichikawa Y, Fujii S, Ohki S. Outcome of total pelvic exenteration for primary rectal cancer. Dis Colon Rectum. 2003;46(4):474-480.
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(4):452-458.
Peeters KC, Marijnen CA, Nagtegaal ID, Kranenbarg EK, Putter H, Wiggers T, et al; Dutch Colorectal Cancer Group. The TME trial after a median follow-up of 6 years: increased local control but no survival benefit in irradiated patients with resectable rectal carcinoma. Ann Surg. 2007;246(5):693-701.
Roh MS, Yothers GA, O'Connell MJ, Beart RW, Pitot HC, et al. The impact of capecitabine and oxaliplatin in the preoperative multimodality treatment in patients with carcinoma of the rectum: NSABP R-04. J Clin Oncol. 2011;29(Suppl):abst 3503.
Yoneda A, Okada K, Matsuo M, Kajiyama M, Kishikawa H. Four cases of locally advanced colorectal cancer resected successfully after preoperative chemotherapy. Gan To Kagaku Ryoho. 2011;38(10):1699-1703.
Lim SB, Choi HS, Jeong SY, Kim DY, Jung KH, Hong YS, et al. Optimal surgery time after preoperative chemoradiotherapy for locally advanced rectal cancers. Ann Surg. 2008;248(2):243-251.
Scutari F, Tramutola G, Morlino A, Rossi MT, Manzione L, Rosati G, Sopranzi A. Downstaging after neoadjuvant therapy for rectal cancer modifies the planned original surgery. G Chir. 2008;29(6-7):277-280.

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