Celine Garrett, Kilian G M Brown, Michael J Solomon, Paul A Sutton, Cherry E Koh, Samuel Aguiar, Tiago S Bezerra, Hamish W Clouston, Ashwin Desouza, Eric J Dozois, Amanda L Ersryd, Frank Frizelle, Jonas A Funder, Julio Garcia-Aguilar, Richard Garfinkle, Tamara Glyn, Alexander Heriot, Yukihide Kanemitsu, Chia Y Kong, Helle Ø Kristensen, Songphol Malakorn, David M Mens, Per J Nilsson, Gabriella J Palmer, Emmanouil Pappou, Martha Quinn, Aaron J Quyn, Chucheep Sahakitrungruang, Avanish Saklani, Arne M Solbakken, Jim P Tiernan, Cornelis Verhoef, Daniel Steffens
{"title":"局部晚期和局部复发直肠癌的常规与高复杂性全盆腔切除：一项国际多中心研究。","authors":"Celine Garrett, Kilian G M Brown, Michael J Solomon, Paul A Sutton, Cherry E Koh, Samuel Aguiar, Tiago S Bezerra, Hamish W Clouston, Ashwin Desouza, Eric J Dozois, Amanda L Ersryd, Frank Frizelle, Jonas A Funder, Julio Garcia-Aguilar, Richard Garfinkle, Tamara Glyn, Alexander Heriot, Yukihide Kanemitsu, Chia Y Kong, Helle Ø Kristensen, Songphol Malakorn, David M Mens, Per J Nilsson, Gabriella J Palmer, Emmanouil Pappou, Martha Quinn, Aaron J Quyn, Chucheep Sahakitrungruang, Avanish Saklani, Arne M Solbakken, Jim P Tiernan, Cornelis Verhoef, Daniel Steffens","doi":"10.1097/DCR.0000000000003986","DOIUrl":null,"url":null,"abstract":"<p><strong>Background: </strong>Pelvic exenteration is the treatment of choice for selected patients with locally advanced primary and recurrent rectal cancer. Involvement of major pelvic neurovascular structures and bone were historically considered contraindications due to unacceptably high rates of morbidity and low R0 resection rates.</p><p><strong>Objective: </strong>To compare the outcomes of these \"high-complexity\" exenterative resections to those of \"conventional\" pelvic exenteration.</p><p><strong>Design: </strong>International multicenter retrospective cohort study.</p><p><strong>Settings: </strong>Sixteen specialized exenteration centers.</p><p><strong>Patients: </strong>Those who underwent total pelvic exenteration for locally advanced primary and recurrent rectal cancer between 2018 and 2023 at participating centers.</p><p><strong>Main outcome measures: </strong>Perioperative resource utilization, morbidity, mortality and R0 resection rates were reported.</p><p><strong>Results: </strong>763 patients underwent total pelvic exenteration, of which 478 (63%) and 285 patients (37%) required conventional and high-complexity procedures, respectively. High-complexity pelvic exenteration was associated with longer operating time (600 vs 480 mins, p < 0.001 for locally advanced primary rectal cancer, 623 vs 480 mins, p < 0.001 for locally recurrent rectal cancer), intensive care stay (2 vs 1 day, p < 0.001 and 3 vs 1 day, p < 0.001), hospital stay (19 vs 15 days, p = 0.008 and 23 vs 15 days, p < 0.001) and higher blood loss (2000 vs 1236 mL, p < 0.001 and 3000 vs 1600 mL, p < 0.001). Morbidity and mortality outcomes, and R0 resection rates were similar between the groups.</p><p><strong>Limitations: </strong>Generalizability of findings outside of expert units.</p><p><strong>Conclusions: </strong>High-complexity pelvic exenteration for the treatment of rectal cancer is associated with similar morbidity, mortality, and R0 resection rates, but significantly higher operative time, blood loss, and hospital resource utilization compared to conventional pelvic exenteration. In high volume, specialized centers, these techniques are considered the standard of care for appropriately selected patients with tumors that involve major pelvic bone or neurovascular structures. 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Involvement of major pelvic neurovascular structures and bone were historically considered contraindications due to unacceptably high rates of morbidity and low R0 resection rates.</p><p><strong>Objective: </strong>To compare the outcomes of these \\\"high-complexity\\\" exenterative resections to those of \\\"conventional\\\" pelvic exenteration.</p><p><strong>Design: </strong>International multicenter retrospective cohort study.</p><p><strong>Settings: </strong>Sixteen specialized exenteration centers.</p><p><strong>Patients: </strong>Those who underwent total pelvic exenteration for locally advanced primary and recurrent rectal cancer between 2018 and 2023 at participating centers.</p><p><strong>Main outcome measures: </strong>Perioperative resource utilization, morbidity, mortality and R0 resection rates were reported.</p><p><strong>Results: </strong>763 patients underwent total pelvic exenteration, of which 478 (63%) and 285 patients (37%) required conventional and high-complexity procedures, respectively. High-complexity pelvic exenteration was associated with longer operating time (600 vs 480 mins, p < 0.001 for locally advanced primary rectal cancer, 623 vs 480 mins, p < 0.001 for locally recurrent rectal cancer), intensive care stay (2 vs 1 day, p < 0.001 and 3 vs 1 day, p < 0.001), hospital stay (19 vs 15 days, p = 0.008 and 23 vs 15 days, p < 0.001) and higher blood loss (2000 vs 1236 mL, p < 0.001 and 3000 vs 1600 mL, p < 0.001). Morbidity and mortality outcomes, and R0 resection rates were similar between the groups.</p><p><strong>Limitations: </strong>Generalizability of findings outside of expert units.</p><p><strong>Conclusions: </strong>High-complexity pelvic exenteration for the treatment of rectal cancer is associated with similar morbidity, mortality, and R0 resection rates, but significantly higher operative time, blood loss, and hospital resource utilization compared to conventional pelvic exenteration. 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引用次数: 0
摘要
背景：盆腔切除是局部晚期原发性和复发性直肠癌患者的首选治疗方法。由于不可接受的高发病率和低R0切除率，累及骨盆主要神经血管结构和骨骼历来被认为是禁忌。目的：比较这些“高复杂性”的盆腔切除与“常规”盆腔切除的结果。设计：国际多中心回顾性队列研究。设置：16个专门的切除中心。患者：2018年至2023年间在参与中心因局部晚期原发性和复发性直肠癌接受全盆腔切除术的患者。主要观察指标：报告围手术期资源利用率、发病率、死亡率和R0切除率。结果：763例患者接受了全盆腔切除，其中478例（63%）和285例（37%）分别需要常规和高复杂性手术。高复杂性的盆腔清除术与较长的操作时间(600 vs 480分钟,p < 0.001为主要局部晚期直肠癌623 vs 480分钟,p < 0.001为局部复发性直肠癌),重症监护室呆(2对1天,p < 0.001和3和1天,p < 0.001),住院(19 vs 15天,p = 0.008和23 vs 15天,p < 0.001)和更高的失血(2000 vs 1236毫升,p < 0.001 vs 1600和3000毫升,p < 0.001)。两组间的发病率、死亡率和R0切除率相似。局限性：专家小组之外的研究结果的普遍性。结论：高复杂性盆腔切除治疗直肠癌的发病率、死亡率和R0切除率相似，但与传统盆腔切除相比，手术时间、出血量和医院资源利用率明显更高。在高容量的专业中心，这些技术被认为是适当选择肿瘤累及主要骨盆骨或神经血管结构的患者的标准护理。参见视频摘要。
Conventional Versus High-Complexity Total Pelvic Exenteration For Locally Advanced and Locally Recurrent Rectal Cancer: An International Multicenter Study.
Background: Pelvic exenteration is the treatment of choice for selected patients with locally advanced primary and recurrent rectal cancer. Involvement of major pelvic neurovascular structures and bone were historically considered contraindications due to unacceptably high rates of morbidity and low R0 resection rates.
Objective: To compare the outcomes of these "high-complexity" exenterative resections to those of "conventional" pelvic exenteration.
Design: International multicenter retrospective cohort study.
Patients: Those who underwent total pelvic exenteration for locally advanced primary and recurrent rectal cancer between 2018 and 2023 at participating centers.
Main outcome measures: Perioperative resource utilization, morbidity, mortality and R0 resection rates were reported.
Results: 763 patients underwent total pelvic exenteration, of which 478 (63%) and 285 patients (37%) required conventional and high-complexity procedures, respectively. High-complexity pelvic exenteration was associated with longer operating time (600 vs 480 mins, p < 0.001 for locally advanced primary rectal cancer, 623 vs 480 mins, p < 0.001 for locally recurrent rectal cancer), intensive care stay (2 vs 1 day, p < 0.001 and 3 vs 1 day, p < 0.001), hospital stay (19 vs 15 days, p = 0.008 and 23 vs 15 days, p < 0.001) and higher blood loss (2000 vs 1236 mL, p < 0.001 and 3000 vs 1600 mL, p < 0.001). Morbidity and mortality outcomes, and R0 resection rates were similar between the groups.
Limitations: Generalizability of findings outside of expert units.
Conclusions: High-complexity pelvic exenteration for the treatment of rectal cancer is associated with similar morbidity, mortality, and R0 resection rates, but significantly higher operative time, blood loss, and hospital resource utilization compared to conventional pelvic exenteration. In high volume, specialized centers, these techniques are considered the standard of care for appropriately selected patients with tumors that involve major pelvic bone or neurovascular structures. See Video Abstract.
期刊介绍：
Diseases of the Colon & Rectum (DCR) is the official journal of the American Society of Colon and Rectal Surgeons (ASCRS) dedicated to advancing the knowledge of intestinal disorders by providing a forum for communication amongst their members. The journal features timely editorials, original contributions and technical notes.
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