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What are the preoperative predictors of a futile pelvic exenteration in rectal cancers?

  • Mufaddal Kazi
    Affiliations
    Department of Surgical Oncology, Tata Memorial Hospital, Mumbai, 400012, India

    Homi Bhabha National Institute, Mumbai, 400012, India
    Search for articles by this author
  • Ashwin Desouza
    Affiliations
    Department of Surgical Oncology, Tata Memorial Hospital, Mumbai, 400012, India

    Homi Bhabha National Institute, Mumbai, 400012, India
    Search for articles by this author
  • Avanish Saklani
    Correspondence
    Corresponding author. Department of Colorectal Surgical Oncology, Tata Memorial Centre, Homi Bhabha National Institute HBNI, Dr Ernest Borges, Marg, Parel, Mumbai, 400012, Maharashtra, India.
    Affiliations
    Department of Surgical Oncology, Tata Memorial Hospital, Mumbai, 400012, India

    Homi Bhabha National Institute, Mumbai, 400012, India
    Search for articles by this author
Published:November 03, 2022DOI:https://doi.org/10.1016/j.ejso.2022.10.022

      Abstract

      Introduction

      Early recurrences and deaths after a morbid procedure like pelvic exenteration are devastating events. The present study aimed at determining the incidence and predictors of futile pelvic exenterations.

      Methods

      Consecutive pelvic exenterations for advanced and recurrent rectal adenocarcinomas operated between January 2013 and January 2021 were included with a minimum of six months follow-up. Futility of exenteration was defined as recurrence or death within six months of operation. Multivariate logistic regression was used to define predictors of futility.

      Results

      Two-hundred eighty-five patients were included and 61 patients (21.4%) had a futile resection. Poorly differentiated (or signet) histology, presence of lateral pelvic nodes, M1 disease, and the need for pelvic bone resections predicted a futile resection. The probability of futility was 10%, 20%, 35–40%, 55–60%, and >75% when none, one, two, three, and all four of the predictors were present. The model was able to correctly predict futility in 70% of the cases suggesting moderate discrimination, and showed good calibration.

      Conclusions

      Futile pelvic exenterations were observed in one-fifth of patients. Four strong predictors of futility were identified. The risk of early failures was additive when combination of these adverse features was present, and can be used for patient selection and prognostication.

      Keywords

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