Br J Surg. 2018 May;105(6):650-657. doi: 10.1002/bjs.10734. Epub 2018 Mar 12.
Pelvic exenteration for locally recurrent rectal cancer (LRRC) is associated with variable outcomes, with the majority of data from single-centre series. This study analysed data from an international collaboration to determine robust parameters that could inform clinical decision-making.
Anonymized data on patients who had pelvic exenteration for LRRC between 2004 and 2014 were accrued from 27 specialist centres. The primary endpoint was survival. The impact of resection margin, bone resection, node status and use of neoadjuvant therapy (before exenteration) was assessed.
Of 1184 patients, 614 (51·9 per cent) had neoadjuvant therapy. A clear resection margin (R0 resection) was achieved in 55·4 per cent of operations. Twenty-one patients (1·8 per cent) died within 30 days and 380 (32·1 per cent) experienced a major complication. Median overall survival was 36 months following R0 resection, 27 months after R1 resection and 16 months following R2 resection (P < 0·001). Patients who received neoadjuvant therapy had more postoperative complications (unadjusted odds ratio (OR) 1·53), readmissions (unadjusted OR 2·33) and radiological reinterventions (unadjusted OR 2·12). Three-year survival rates were 48·1 per cent, 33·9 per cent and 15 per cent respectively. Bone resection (when required) was associated with a longer median survival (36 versus 29 months; P < 0·001). Node-positive patients had a shorter median overall survival than those with node-negative disease (22 versus 29 months respectively). Multivariable analysis identified margin status and bone resection as significant determinants of long-term survival.
Negative margins and bone resection (where needed) were identified as the most important factors influencing overall survival. Neoadjuvant therapy before pelvic exenteration did not affect survival, but was associated with higher rates of readmission, complications and radiological reintervention.
局部复发性直肠癌（LRRC）的盆腔廓清术的结果存在差异，多数数据来自单中心研究。本研究通过国际合作分析数据，以确定可用于指导临床决策的可靠参数。
从 27 个专业中心收集了 2004 年至 2014 年间接受 LRRC 盆腔廓清术的患者的匿名数据。主要终点是生存。评估了切缘、骨切除、淋巴结状态和新辅助治疗（在廓清术前）的影响。
1184 例患者中，614 例（51.9%）接受了新辅助治疗。55.4%的手术获得了明确的切缘（R0 切除）。21 例（1.8%）患者在术后 30 天内死亡，380 例（32.1%）发生重大并发症。R0 切除后中位总生存期为 36 个月，R1 切除后为 27 个月，R2 切除后为 16 个月（P<0.001）。接受新辅助治疗的患者术后并发症更多（调整后的优势比（OR）为 1.53）、再入院率（调整后的 OR 为 2.33）和影像学再干预率（调整后的 OR 为 2.12）更高。3 年生存率分别为 48.1%、33.9%和 15%。当需要时，骨切除与更长的中位生存时间相关（36 个月比 29 个月；P<0.001）。淋巴结阳性患者的总生存时间短于淋巴结阴性患者（分别为 22 个月和 29 个月）。多变量分析确定切缘状态和骨切除是影响长期生存的最重要因素。盆腔廓清术前新辅助治疗并未影响生存，但与更高的再入院率、并发症和影像学再干预率相关。
