Department of Surgery and Cancer, Imperial College London, London, UK.
Pelican Cancer Foundation, Basingstoke, UK.
Colorectal Dis. 2024 Oct;26(10):1805-1814. doi: 10.1111/codi.17137. Epub 2024 Aug 15.
The clinical burden of pelvic exenteration (PE) for locally advanced rectal cancer (LARC) is nationally under-reported. The widespread use of pelvic MRI since 2005 has increased the accuracy of local staging and awareness of the need for 'beyond TME (total mesorectal excision)' surgery. The aim of this study was to assess the volume of patients undergoing PE within England, which factors affected survival outcomes and whether the use of MRI has influenced these outcomes.
The volume of patients undergoing PE and associated survival outcomes across England between 1995 and 2016 was evaluated from Public Health England Hospital Episode Statistics data.
A total of 2996 patients were recorded as undergoing PE. The 5-year overall survival rate improved after 2005 compared with prior to 2005 (61.7% vs. 37%, p < 0.001), with no significant difference between cancer registries throughout England. After 2005, the volume of patients undergoing PE and undergoing preoperative MRI increased, as did the number of non-T4 cancers operated on. After 2005, age, preoperative MRI and preoperative radiotherapy were the significant factors influencing 5-year overall survival on multivariate analysis.
This review of national data confirms that PE outcomes are under-reported. MRI staging aids with the identification of patients suitable for perioperative treatment, surgery or palliation and facilitates treatment planning. Since 2005, MRI, likely in combination with advances in surgery and perioperative treatment, has improved survival outcomes. It is imperative that detailed information from patients with LARC undergoing PE is captured and reported in order to optimize care and future service provision.
盆腔廓清术（PE）治疗局部晚期直肠癌（LARC）的临床负担在全国范围内报道不足。自 2005 年以来，盆腔 MRI 的广泛应用提高了局部分期的准确性，并提高了对“超越 TME（直肠系膜全切除）”手术的必要性的认识。本研究旨在评估英国接受 PE 治疗的患者数量、影响生存结果的因素，以及 MRI 的使用是否影响这些结果。
从英国公共卫生英格兰医院发病统计数据中评估了 1995 年至 2016 年期间英国接受 PE 治疗的患者数量及其相关生存结果。
共记录了 2996 例接受 PE 治疗的患者。与 2005 年之前相比，2005 年后患者的 5 年总生存率有所提高（61.7%对 37%，p<0.001），但英格兰各地的癌症登记处之间没有显著差异。2005 年后，接受 PE 治疗和术前 MRI 检查的患者数量以及非 T4 期癌症手术数量增加。2005 年后，年龄、术前 MRI 和术前放疗是多因素分析中影响 5 年总生存率的显著因素。
对全国数据的回顾证实，PE 治疗结果报告不足。MRI 分期有助于识别适合围手术期治疗、手术或姑息治疗的患者，并有助于治疗计划的制定。自 2005 年以来，MRI 检查（可能与手术和围手术期治疗的进步相结合）提高了生存结果。为了优化护理和未来的服务提供，必须从接受 PE 治疗的 LARC 患者中获取和报告详细信息。
