Xin Koh Ye, Ng Deanna Wan Jie, Tan Grace Hwei Ching, Teo Melissa Ching Ching
Department of Surgical Oncology, National Cancer Centre Singapore, 9 Hospital Drive, Singapore, 169612, Singapore.
J Gastrointest Cancer. 2014 Sep;45(3):291-7. doi: 10.1007/s12029-014-9586-y.
A review of a single-centre experience of pelvic exenteration as a treatment modality for patients with locally advanced primary and recurrent rectal cancer. The perioperative outcomes, morbidity and long term oncological outcomes are reviewed.
MATERIALS & METHODS: Patients undergoing pelvic exenterations for recurrent and locally advanced rectal cancer between 1 January 2006 and 1 August 2012 were identified from a prospective database. All patients underwent pre-operative staging investigations with computed tomography (CT) scan of chest, abdomen and pelvis and pelvic magnetic resonance imaging (MRI). Patients with locally advanced primary rectal cancer were counselled for pre-operative chemoradiation. Structures such as the urinary bladder and female reproductive organs were resected en bloc where indicated with the lesion. Urological or plastic reconstructions were employed where indicated. The primary outcome measured was overall survival and secondary outcomes measured were time to local recurrence (LR) and systemic recurrence. Disease-free survival was examined by the Kaplan-Meier Method (Fig. 1).
Pelvic exenterations were performed in 13 patients with a median age of 59 (range 26-81). The rate of major post-operative complications was 8% (n = 1), where the patient had anastomotic leakage. There were no mortalities in the perioperative period. All patients were operated with curative intent and negative circumferential margins were shown in 9 out of 13 patients (70%). The DFS was 19.4 and the OS was 22.5 months.
An aggressive approach with en bloc resection of organs involved provides survival benefit to patients with locally advanced primary and recurrent rectal cancer with an acceptable morbidity profile.
回顾单中心将盆腔脏器清除术作为局部晚期原发性和复发性直肠癌患者治疗方式的经验。对围手术期结果、发病率和长期肿瘤学结果进行回顾。
从一个前瞻性数据库中识别出2006年1月1日至2012年8月1日期间因复发性和局部晚期直肠癌接受盆腔脏器清除术的患者。所有患者均接受了胸部、腹部和盆腔的计算机断层扫描（CT）以及盆腔磁共振成像（MRI）的术前分期检查。对于局部晚期原发性直肠癌患者，建议进行术前放化疗。在有指征时，将膀胱和女性生殖器官等结构与病变一并整块切除。在有指征时采用泌尿外科或整形重建。测量的主要结局是总生存期，测量的次要结局是局部复发（LR）和全身复发时间。采用Kaplan-Meier法检查无病生存期（图1）。
13例患者接受了盆腔脏器清除术，中位年龄为59岁（范围26 - 81岁）。主要术后并发症发生率为8%（n = 1），该患者发生了吻合口漏。围手术期无死亡病例。所有患者均以治愈为目的进行手术，13例患者中有9例（70%）切缘阴性。无病生存期为19.4个月，总生存期为22.5个月。
对受累器官进行整块切除的积极方法为局部晚期原发性和复发性直肠癌患者提供了生存益处，且发病率可接受。
