A systematic review of oncosurgical and quality of life outcomes following pelvic exenteration for locally advanced and recurrent rectal cancer.

IF 1.1 4区 医学 Q3 SURGERY
J Maudsley, R E Clifford, O Aziz, P A Sutton
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引用次数: 0

Abstract

Introduction: Pelvic exenteration (PE) is now the standard of care for locally advanced (LARC) and locally recurrent (LRRC) rectal cancer. Reports of the significant short-term morbidity and survival advantage conferred by R0 resection are well established. However, longer-term outcomes are rarely addressed. This systematic review focuses on long-term oncosurgical and quality of life (QoL) outcomes following PE for rectal cancer.

Methods: A systematic review of the PubMed®, Cochrane Library, MEDLINE® and Embase® databases was conducted, in accordance with the PRISMA (Preferred Reporting Items for Systematic reviews and Meta-Analyses) guidelines. Studies were included if they reported long-term outcomes following PE for LARC or LRRC. Studies with fewer than 20 patients were excluded.

Findings: A total of 25 papers reported outcomes for 5,489 patients. Of these, 4,744 underwent PE for LARC (57.5%) or LRRC (42.5%). R0 resection rates ranged from 23.2% to 98.4% and from 14.9% to 77.8% respectively. The overall morbidity rates were 17.8-87.0%. The median survival ranged from 12.5 to 140.0 months. None of these studies reported functional outcomes and only four studies reported QoL outcomes. Numerous different metrics and timepoints were utilised, with QoL scores frequently returning to baseline by 12 months.

Conclusions: This review demonstrates that PE is safe, with a good prospect of R0 resection and acceptable mortality rates in selected patients. Morbidity rates remain high, highlighting the importance of shared decision making with patients. Longer-term oncological outcomes as well as QoL and functional outcomes need to be addressed in future studies. Development of a core outcomes set would facilitate better reporting in this complex and challenging patient group.

盆腔外扩张术治疗局部晚期和复发性直肠癌的手术效果和生活质量的系统性回顾。
简介:盆腔外扩张术(PE)是目前治疗局部晚期(LARC)和局部复发(LRRC)直肠癌的标准方法。R0 切除术在短期发病率和生存率方面具有显著优势,这一点已得到公认。然而,长期疗效却鲜有报道。本系统性综述侧重于直肠癌PE术后的长期手术和生活质量(QoL)结果:方法:根据 PRISMA(系统综述和元分析首选报告项目)指南,对 PubMed®、Cochrane 图书馆、MEDLINE® 和 Embase® 数据库进行了系统综述。如果研究报告了 LARC 或 LRRC PE 后的长期疗效,则将其纳入研究。少于 20 名患者的研究被排除在外:共有 25 篇论文报告了 5489 名患者的治疗结果。其中,4744 名患者因 LARC(57.5%)或 LRRC(42.5%)接受了 PE。R0切除率分别为23.2%至98.4%和14.9%至77.8%。总发病率为17.8%-87.0%。中位生存期从12.5个月到140.0个月不等。这些研究均未报告功能性结果,仅有四项研究报告了 QoL 结果。研究采用了许多不同的指标和时间点,QoL评分经常在12个月后恢复到基线水平:本综述表明,PE 是安全的,在选定的患者中,R0 切除的前景良好,死亡率可接受。发病率仍然很高,这凸显了与患者共同决策的重要性。在未来的研究中,需要探讨较长期的肿瘤学结果以及 QoL 和功能性结果。制定一套核心结果将有助于更好地报告这一复杂而具有挑战性的患者群体。
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来源期刊
CiteScore
2.40
自引率
0.00%
发文量
316
期刊介绍: The Annals of The Royal College of Surgeons of England is the official scholarly research journal of the Royal College of Surgeons and is published eight times a year in January, February, March, April, May, July, September and November. The main aim of the journal is to publish high-quality, peer-reviewed papers that relate to all branches of surgery. The Annals also includes letters and comments, a regular technical section, controversial topics, CORESS feedback and book reviews. The editorial board is composed of experts from all the surgical specialties.
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