Department of Surgical Oncology, Manipal Comprehensive Cancer Care Center, Kasturba Medical College, Manipal Academy of Higher Education (MAHE), Manipal, Karnataka, 576104, India.
Department of Colorectal Surgical Oncology, Tata Memorial Centre, Homi Bhabha National Institute (HBNI), Dr Ernest Borges Marg, Parel, Mumbai, Maharashtra, 400012, India.
Langenbecks Arch Surg. 2021 May;406(3):821-831. doi: 10.1007/s00423-021-02143-7. Epub 2021 Mar 17.
The aim was to evaluate the oncological outcomes and the prognostic factors following pelvic exenteration (PE) in cT4 and fixed cT3 stage primary rectal adenocarcinoma and to study the impact of consolidation chemotherapy following neoadjuvant concurrent chemoradiotherapy (NACRT).
A retrospective analysis of a prospectively maintained database of PE from 2013 to 2018.
Out of 2900 colorectal resections, there were 131 pelvic exenterations that were performed, and 100 of these patients had undergone exenteration for primary rectal adenocarcinoma. Of these 100 patients, there were 81 patients who had received NACRT followed by surgery, 50 of whom who had received consolidation chemotherapy and 31 who had undergone surgery without consolidation chemotherapy. R0 resection was achieved in 90% cases. At a median follow-up of 32 months, 2-year disease free survival was 61.8% and estimated 5-year overall survival was 62%. The incidence of distant metastases was 44% vs. 19% (p = 0.023), and the 2-year distant recurrence-free survival was 58% vs. 89% (p = 0.025), respectively, in the 'consolidation chemotherapy group' and the 'no chemotherapy group'. The poorly differentiated grade of tumours, presence of lympho-vascular-invasion, consolidation chemotherapy, and disease recurrence were all found to affect the survival.
PE with R0 resection achieves excellent survival rates in cT4 and fixed cT3 stage primary rectal adenocarcinoma. The distant recurrence rate may not be altered by consolidation chemotherapy in the subset of high-risk patients. However, further research on consolidation chemotherapy following NACRT in cT4 and fixed cT3 stage primary rectal adenocarcinoma will give a definite answer in the future.
评估 cT4 和固定 cT3 期原发性直肠腺癌行盆腔廓清术（PE）后的肿瘤学结果和预后因素，并研究新辅助同期放化疗（NACRT）后巩固化疗的影响。
回顾性分析 2013 年至 2018 年前瞻性维持的 PE 数据库。
在 2900 例结直肠切除术中，有 131 例进行了盆腔廓清术，其中 100 例为原发性直肠腺癌行廓清术。在这 100 例患者中，有 81 例接受了 NACRT 后手术治疗，其中 50 例接受了巩固化疗，31 例未接受巩固化疗即行手术。90%的病例达到了 R0 切除。中位随访 32 个月时，2 年无病生存率为 61.8%，估计 5 年总生存率为 62%。远处转移的发生率分别为 44%和 19%（p=0.023），远处无复发生存率分别为 58%和 89%（p=0.025），分别为“巩固化疗组”和“无化疗组”。肿瘤分化程度差、存在淋巴血管侵犯、巩固化疗和疾病复发均影响生存。
在 cT4 和固定 cT3 期原发性直肠腺癌中，行 R0 切除的 PE 可获得极好的生存率。在高危患者亚组中，巩固化疗可能不会改变远处复发率。然而，未来将进一步研究 NACRT 后在 cT4 和固定 cT3 期原发性直肠腺癌中应用巩固化疗的效果。
