Colorectal Unit, Derriford Hospital, Plymouth Hospital NHS Trust, Plymouth, UK.
Tech Coloproctol. 2018 Nov;22(11):835-845. doi: 10.1007/s10151-018-1883-1. Epub 2018 Dec 1.
Pelvic exenteration represents the best treatment option for cure of locally advanced or recurrent rectal cancer. This systematic review sought to evaluate current literature regarding short and long term treatment outcomes and long term survival following pelvic exenteration.
A systematic search of the MEDLINE, PubMed and Ovid databases was conducted to identify suitable articles published between 2001 and 2016. The article search was performed in line with Cochrane methodology and reported according to the Preferred Reporting Items for Systematic reviews and Meta-analyses statement.
Sixteen studies were included in the final analysis, incorporating 1016 patients. Sixty-three percent of patients were male and median patient age was 59 years. Median operating time was 7.2 h with median blood loss of 1.9 l. Median postoperative stay was 17 days with a median 30-day mortality of 0. Complication rates were 31.6-86% with a return to theatre rate of 14.6%. Median R0 resection rate was 74% and was higher for primary cancer (82.6% versus 58% for recurrent cancer). Mean overall survival was 31 months and median 5-year survival was 32%. Recurrently identified indicators of adverse outcome included R1/2 resection, preoperative pelvic pain and previous abdominoperineal resection of the rectum.
Pelvic exenteration remains a major operation associated with significant morbidity and mortality. Despite advances in preoperative assessment and staging, R1 resection rates remain high. There is also a high degree of variability of reporting outcomes and standardisation of this process would aid comparison of results between centres and drive forward research in this area.
盆腔廓清术是局部晚期或复发性直肠癌的最佳治疗选择。本系统评价旨在评估当前关于盆腔廓清术后短期和长期治疗结果以及长期生存的文献。
对 MEDLINE、PubMed 和 Ovid 数据库进行系统检索，以确定 2001 年至 2016 年期间发表的合适文章。文章检索符合 Cochrane 方法，并根据系统评价和荟萃分析的首选报告项目进行报告。
最终分析纳入了 16 项研究，共纳入 1016 例患者。63%的患者为男性，中位患者年龄为 59 岁。中位手术时间为 7.2 小时，中位出血量为 1.9 升。中位术后住院时间为 17 天，中位 30 天死亡率为 0。并发症发生率为 31.6%-86%，再次手术率为 14.6%。中位 R0 切除率为 74%，原发性癌症的切除率更高（82.6% vs 58%，复发性癌症）。总生存的平均时间为 31 个月，中位 5 年生存率为 32%。反复确定的不良预后指标包括 R1/2 切除、术前盆腔疼痛和先前的腹会阴直肠切除术。
盆腔廓清术仍然是一种与高发病率和死亡率相关的重大手术。尽管术前评估和分期有所进展，但 R1 切除率仍然很高。报告结果的差异也很大，该过程的标准化将有助于中心之间的结果比较，并推动该领域的研究。
