Abstract
Introduction
In patients with locally advanced (LARC) or locally recurrent (LRRC) rectal cancer
and bladder involvement, pelvic exenteration (PE) with partial (PC) or radical (RC)
cystectomy can potentially offer a cure. The study aim was to compare PC and RC in
PE patients in terms of oncological outcome, post-operative complications and quality-of-life
(QoL).
Materials & methods
This was a retrospective cohort analysis of a prospectively maintained surgical database.
Patients who underwent PE for LARC or LRRC cancer with bladder involvement between
1998 and 2021 were included. Post-operative complications and overall survival were
compared between patients with PC and RC.
Results
60 PC patients and 269 RC patients were included. Overall R0 resection was 84.3%.
Patients with LRRC and PC had poorest oncological outcome with 69% R0 resection; patients
with LARC and PC demonstrated highest R0 rate of 96.3% (P = 0.008). Overall, 1-, 3-
and 5-year OS was 90.8%, 68.1% and 58.6% after PC, and 88.7%, 62.2% and 49.5% after
RC. Rates of urinary sepsis or urological leaks did not differ between groups, however,
RC patients experienced significantly higher rates of perineal wound- and flap-related
complications (39.8% vs 25.0%, P = 0.032).
Conclusion
PC as part of PE can be performed safely with good oncological outcome in patients
with LARC. In patients with LRRC, PC results in poor oncological outcome and a more
aggressive surgical approach with RC seems justified. The main benefit of PC is a
reduction in wound related complications compared to RC, although more urological
re-interventions are observed in this group.
Keywords
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Article info
Publication history
Published online: January 09, 2023
Accepted:
January 2,
2023
Received in revised form:
December 15,
2022
Received:
October 10,
2022
Publication stage
In Press Journal Pre-ProofFootnotes
☆Accepted as a concurrent session abstract at the Urological Association of Asia, Sydney, October 5 to 8, 2022. Accepted for poster presentation at European Society of Coloproctology conference, Dublin, September 21–23, 2022.
Identification
Copyright
© 2023 Elsevier Ltd, BASO ~ The Association for Cancer Surgery, and the European Society of Surgical Oncology. All rights reserved.
