Total pelvic exenteration for rectal cancer: outcomes and prognostic factors

• Published in: Canadian Journal of Surgery Vol. 54; no. 6; pp. 387 - 393
• Main Authors: Domes, Trustin S., MD, Colquhoun, Patrick H.D., MD, Taylor, Brian, MD, Izawa, Jonathan I., MD, House, Andrew A., MD, Luke, Patrick P.W., MD
• Format: Journal Article
• Language: English
• Published: Canada CMA Joule Inc 01.12.2011; CMA Impact, Inc; Canadian Medical Association
• Subjects: Adenocarcinoma - mortality; Adenocarcinoma - pathology; Adenocarcinoma - surgery; Adult; Aged; Body Mass Index; Care and treatment; Colorectal cancer; Female; Humans; Lymphatic Metastasis; Male; Medical prognosis; Middle Aged; Neoplasm Recurrence, Local - surgery; Patient outcomes; Pelvic Exenteration; Postoperative Complications - epidemiology; Prognosis; Rectal Neoplasms - mortality; Rectal Neoplasms - pathology; Rectal Neoplasms - surgery; Retrospective Studies; Studies; Surgery; Surgical outcomes; Survival Analysis; Treatment Outcome; Canada
• ISSN: 0008-428X; 1488-2310
• DOI: 10.1503/cjs.014010

Background To perform complete resection of locally advanced and recurrent rectal carcinoma, total pelvic exenteration (TPE) may be attempted. We identified disease-related outcomes and prognostic factors. Methods We conducted a single-centre review of patients who underwent TPE for rectal carcinoma over a 10-year period. Results We included 28 patients in our study. After a median follow-up of 35 months, 53.6 % of patients were alive with no evidence of disease. The 3-year actuarial disease-free and overall survival rates were 52.2 % and 75.1 %, respectively. On univariate analysis, recurrent disease, preoperative body mass index greater than 30 and lymphatic invasion were poor prognostic factors for disease-free survival, and only lymphatic invasion predicted overall survival. Additionally, multivariate analysis identified lymphatic invasion as an independent poor prognostic factor for disease-free survival in this patient population with locally advanced and recurrent rectal carcinoma. Conclusion Despite the significant morbidity, TPE can provide long-term survival in patients with rectal carcinoma. Additionally, lymphatic invasion on final pathology was an independent prognostic factor for disease-free survival.