Quyn Aaron J, Solomon Michael J, Lee Peter M, Badgery-Parker Tim, Masya Lindy M, Young Jane M
1 Department of Colorectal Surgery, Royal Prince Alfred Hospital, Sydney, New South Wales, Australia 2 Surgical Outcomes Research Centre, Royal Prince Alfred Hospital, Sydney, New South Wales, Australia 3 Cancer Epidemiology and Cancer Services Research, Sydney School of Public Health, Sydney, New South Wales, Australia.
Dis Colon Rectum. 2016 Nov;59(11):1005-1010. doi: 10.1097/DCR.0000000000000679.
Locally advanced pelvic malignancy can be associated with disabling symptoms and reduced quality of life. If resectable with clear margins, a pelvic exenteration can offer long-term survival and improved quality of life. Its role in the palliation of symptoms has been described; however, the clinical outcomes and surgical indication are poorly defined.
This study describes the clinical and quality-of-life outcomes after palliative pelvic exenteration for advanced pelvic malignancy.
Clinical data and patient-reported outcomes were collected for patients undergoing pelvic exenteration for symptom palliation.
This study was conducted at a tertiary referral center for pelvic exenteration.
All of the patients undergoing palliative pelvic exenteration for advanced primary rectal or recurrent cancer were included in our analysis.
Patient-reported quality of life and physical and mental health status were measured. Quality-of-life trajectories were modeled over the 12 months from the date of surgery using linear mixed models.
A total of 39 patients underwent pelvic exenteration for symptom palliation. Although there were no in-hospital deaths, 34% experienced significant morbidity. Patient-reported quality of life reduced postoperatively and gradually declined thereafter. Overall median survival was 24 months, with a 1-year mortality rate of 31%. There was a significant survival difference for the 39 patients undergoing pelvic exenteration compared with those patients who only had a debulking/bypass procedure or were closed without definitive treatment (overall median survival = 24 versus 9 months; p = <0.02).
Disease and patient heterogeneity limit the interpretation of these results.
Palliative pelvic exenteration is a technically demanding operation that can be performed safely in a dedicated exenteration center. However, no durable palliation of symptoms with associated improved or sustained quality of life was observed, and the role of palliation therefore remains highly controversial in this complex group of patients.
局部晚期盆腔恶性肿瘤可伴有致残症状，生活质量下降。如果能在切缘清晰的情况下进行切除，盆腔脏器清除术可实现长期生存并改善生活质量。其在缓解症状方面的作用已有描述；然而，临床结局和手术指征尚不明确。
本研究描述晚期盆腔恶性肿瘤姑息性盆腔脏器清除术后的临床及生活质量结局。
收集接受盆腔脏器清除术以缓解症状患者的临床数据及患者报告结局。
本研究在一家盆腔脏器清除术的三级转诊中心开展。
所有因晚期原发性直肠癌或复发性癌接受姑息性盆腔脏器清除术的患者均纳入我们的分析。
测量患者报告的生活质量以及身心健康状况。使用线性混合模型对自手术日期起12个月内的生活质量轨迹进行建模。
共有39例患者接受盆腔脏器清除术以缓解症状。虽然无院内死亡病例，但34%的患者出现严重并发症。患者报告的生活质量术后降低，此后逐渐下降。总体中位生存期为24个月，1年死亡率为31%。与仅接受减瘤/旁路手术或未进行确定性治疗而关闭创口的患者相比，接受盆腔脏器清除术的39例患者存在显著的生存差异（总体中位生存期分别为24个月和9个月；p = <0.02）。
疾病和患者的异质性限制了对这些结果的解读。
姑息性盆腔脏器清除术是一项技术要求较高的手术，可在专门的脏器清除中心安全进行。然而，未观察到症状的持久缓解以及生活质量的改善或维持，因此在这一复杂患者群体中，姑息治疗的作用仍极具争议。
