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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References
- T4 rectal cancer: analysis of patient outcome after surgical excision.Am Surg. 2005 Nov; 71 (; discussion 904): 901-903
- Colorectal cancer in India: an audit from a tertiary center in a low prevalence area.Indian J Surg Oncol. 2017 Dec; 8: 484-490
- State-of-the-art surgery for recurrent and locally advanced rectal cancers.Langenbeck's Arch Surg. 2021 Sep; 406: 1763-1774
- Preventing futile liver resection: a risk-based approach to surgical selection in major hepatectomy for colorectal cancer.Ann Surg Oncol. 2022 Feb; 29: 905-912
- Surgical and survival outcomes following pelvic exenteration for locally advanced primary rectal cancer: results from an international collaboration.Ann Surg. 2019 Feb; 269: 315-321
- Rectal cancer, version 2.2018, NCCN clinical practice guidelines in oncology.J Natl Compr Cancer Netw. 2018 Jul; 16: 874-901
- Minimally invasive versus open pelvic exenterations for rectal cancer: a comparative analysis of perioperative and 3-year oncological outcomes.BJS Open. 2021 Sep 6; 5: zrab074
- Lateral nodal features on restaging magnetic resonance imaging associated with lateral local recurrence in low rectal cancer after neoadjuvant chemoradiotherapy or radiotherapy.JAMA Surg. 2019 Sep 1; 154e192172
- Comparison of magnetic resonance imaging and histopathological response to chemoradiotherapy in locally advanced rectal cancer.Ann Surg Oncol. 2012 Sep; 19: 2842-2852
- Classification of surgical complications: a new proposal with evaluation in a cohort of 6336 patients and results of a survey.Ann Surg. 2004 Aug; 240: 205-213
- Pathology Review Committee, et al. Circumferential margin involvement is still an important predictor of local recurrence in rectal carcinoma: not one millimeter but two millimeters is the limit.Am J Surg Pathol. 2002 Mar; 26: 350-357
- Correcting for optimistic prediction in small data sets.Am J Epidemiol. 2014 Aug 1; 180: 318-324
- Prognoses of different pathological subtypes of colorectal cancer at different stages: a population-based retrospective cohort study.BMC Gastroenterol. 2019 Oct 10; 19: 164
- Adenocarcinoma of the rectum-A composite of three different subtypes with varying outcomes?.Clin Colorectal Cancer. 2016 Jun; 15: e47-e52
- Optimal neoadjuvant strategy for signet ring cell carcinoma of the rectum-Is TNT the solution?.J Surg Oncol. 2021 Dec; 124: 1417-1430
- Pelvic exenteration combined with cytoreductive surgery and hyperthermic intraperitoneal chemotherapy for advanced primary or recurrent colorectal cancer with peritoneal metastases.Colorectal Dis. 2021 Jan; 23: 186-191
- Total pelvic exenteration, cytoreductive surgery, and hyperthermic intraperitoneal chemotherapy for rectal cancer with associate peritoneal metastases: surgical strategies to optimize safety.Cancers. 2020 Nov 23; 12: 3478
- Impact of histological subtype on treatment outcomes in locally advanced rectal adenocarcinoma treated with neoadjuvant chemoradiation.Acta Oncol. 2018 Dec; 57: 1721-1723
- Extended radical resection: the standard of care for patients with advanced pelvic malignancy.Ann Surg Oncol. 2020 Feb; 27: 323-324
- Influence of the level of sacrectomy on survival in patients with locally advanced and recurrent rectal cancer.Br J Surg. 2019 Mar; 106: 484-490
- Sciatic and femoral nerve resection during extended radical surgery for advanced pelvic tumours: long-term survival, functional, and quality-of-life outcomes.Ann Surg. 2021 May 1; 273: 982-988
- Catastrophic expenditure and treatment attrition in patients seeking comprehensive colorectal cancer treatment in India: a prospective multicentre study.Lancet Reg Health Southeast Asia. 2022 Nov 1; 6 ([cited 2022 Oct 5]) (Available from:)
- Neoadjuvant chemotherapy with FOLFIRINOX and preoperative chemoradiotherapy for patients with locally advanced rectal cancer (UNICANCER-PRODIGE 23): a multicentre, randomised, open-label, phase 3 trial.Lancet Oncol. 2021 Apr 13; 22: 702-705
- Short-course radiotherapy followed by chemotherapy before total mesorectal excision (TME) versus preoperative chemoradiotherapy, TME, and optional adjuvant chemotherapy in locally advanced rectal cancer (RAPIDO): a randomised, open-label, phase 3 trial.Lancet Oncol. 2021 Jan; 22: 29-42
Article info
Publication history
Published online: November 03, 2022
Accepted:
October 31,
2022
Received in revised form:
October 6,
2022
Received:
September 6,
2022
Identification
Copyright
© 2022 Elsevier Ltd, BASO ~ The Association for Cancer Surgery, and the European Society of Surgical Oncology. All rights reserved.
