Colorectal Surgery Division, Department of Surgery, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand.
Dis Colon Rectum. 2018 May;61(5):561-566. doi: 10.1097/DCR.0000000000001083.
Pelvic exenteration carries significant risks of morbidity and mortality. Preoperative management is therefore crucial, and the exenteration procedure is usually performed in an elective setting. In cases of rectal cancer, however, tumor-related complications may cause a patient's condition to deteriorate rapidly, despite optimal management. Urgent pelvic exenteration then may be an option for these patients.
This study aims to compare the outcomes of pelvic exenteration between the urgent and elective settings.
This is a retrospective study.
This study was conducted at King Chulalongkorn Memorial Hospital between February 2006 and June 2012.
Fifty-three patients with locally advanced rectal cancer were included.
All patients underwent pelvic exenteration for locally advanced rectal cancer. They were assigned to urgent and elective setting groups according to their preoperative conditions. The urgent setting group included patients who required urgent pelvic exenteration because of intestinal obstruction, bowel perforation, bleeding, or uncontrolled sepsis, despite optimal management preoperatively.
Twenty-six patients were classified in the urgent setting group, and 27 were classified in the elective setting group. Three-year overall and disease-free survivals were compared between the 2 groups. Thirty-day postoperative morbidity and mortality were also studied.
Three-year overall survival was 62.2% and 54.4% in the elective and urgent groups (p = 0.7), whereas three-year disease-free survival was 43% and 63.8% (p = 0.33). The median follow-up time was 33 months. Thirty-day morbidity did not differ between the 2 groups (p = 0.49). A low serum albumin level was a significant risk factor for complications. There was no postoperative mortality in this study.
This was a retrospective study performed at 1 institution, and it lacked quality-of-life scores.
Pelvic exenteration in an urgent setting is feasible and could offer acceptable outcomes. See Video Abstract at http://links.lww.com/DCR/A591.
盆腔廓清术具有显著的发病率和死亡率风险。因此，术前管理至关重要，该手术通常在择期情况下进行。然而，在直肠癌的情况下，尽管进行了最佳管理，肿瘤相关并发症仍可能导致患者病情迅速恶化。对于这些患者，紧急盆腔廓清术可能是一种选择。
本研究旨在比较紧急和择期情况下盆腔廓清术的结果。
这是一项回顾性研究。
本研究于 2006 年 2 月至 2012 年 6 月在朱拉隆功国王纪念医院进行。
纳入 53 例局部晚期直肠癌患者。
所有患者均因局部晚期直肠癌行盆腔廓清术。根据术前情况将患者分为紧急和择期手术组。紧急手术组包括尽管术前进行了最佳管理，但仍因肠梗阻、肠穿孔、出血或无法控制的败血症而需要紧急盆腔廓清术的患者。
26 例患者归入紧急手术组，27 例归入择期手术组。比较两组患者的 3 年总生存率和无病生存率。还研究了两组患者的 30 天术后发病率和死亡率。
择期手术组和紧急手术组患者的 3 年总生存率分别为 62.2%和 54.4%（p = 0.7），3 年无病生存率分别为 43%和 63.8%（p = 0.33）。中位随访时间为 33 个月。两组患者的 30 天发病率无差异（p = 0.49）。低血清白蛋白水平是发生并发症的显著危险因素。本研究中无术后死亡。
这是一项在单机构进行的回顾性研究，缺乏生活质量评分。
紧急情况下进行盆腔廓清术是可行的，可获得可接受的结果。在 http://links.lww.com/DCR/A591 观看视频摘要。
