Early failure following pelvic exenteration: Who are the bad actors?

Ben Creavin, Michael Eamon Kelly, Jawed Noori, Greg Turner, Glen Guerra, Cori Behrenbruch, Helen Mohan, Joe Kong, Jacob McCormick, Satish Warrier, Alexander Heriot
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Abstract

Background: Pelvic exenteration for locally advanced (LARC) or recurrent rectal cancer (LRRC) is technically challenging with considerable morbidity for the patient. Though surgery can confer long-term survival in selected patients, early failure, defined as recurrence with one year, represents a major issue as both survival and quality of life are severely impacted. This study aims to highlight the "bad actors" associated with early failure.

Methods: A retrospective study of patients who underwent exenteration for LARC & LRRC in a quaternary referral unit was performed. Specifically, characteristics of patients with early recurrence were identified and compared to those who recurred after one year.

Results: 159 and 85 patients underwent pelvic exenteration for LARC and LRRC, respectively. Of these, there were 61 (38.3 %) recurrences in the LARC and 74 (87.1 %) LRRC cohorts. For LARC, 18 patients had an early failure. Expectantly, these patients had a higher proportion of positive margins (R1) (50 % vs. 21 % in the remaining 141 patients, ∗p = 0.04). Interestingly, early failure was also associated with more genetic mutations (33 % vs. 22 %), extramural venous invasion (32 % vs. 24 %), lymphovascular invasion (38 % vs. 22 %), and other adverse histopathological features including poor-differentiation, signet-ring and/or mucinous disease (38 % vs. 21 %). Median and 3-year overall survival (OS) in the early failure group compared to the rest of the cohort was 96 months versus 30 months and 35 % versus 73 %, respectively (∗p = 0.003). There were 18 early failures in the LRRC cohort. Similarly, there were more patients with positive margins in the early failure group (55 % versus 39 %, ∗p = 0.02). The early failure group was also associated with extramural venous invasion (38 % versus 23 %) and adverse histopathological features (55 % versus 28 %). Median and 3-year overall survival (OS) in the early failure group compared to the non-early-failure group was 15 versus 0 months and 17 % versus 68 % respectively (∗p=<0.001).

Conclusion: Tailoring treatment strategies according to tumour characteristics is increasingly important in the management of advanced rectal cancer. Multicentre data is needed to validate these findings and would have a profound impact to patient counselling and outcome expectations.

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背景:局部晚期(LARC)或复发性直肠癌(LRRC)的盆腔外扩手术在技术上具有挑战性,患者的发病率相当高。虽然手术可使部分患者获得长期生存,但早期失败(指一年内复发)是一个重大问题,因为生存和生活质量都会受到严重影响。本研究旨在强调与早期失败相关的 "坏人":方法:对在一家四级转诊医院接受 LARC 和 LRRC 手术的患者进行了一项回顾性研究。具体而言,研究人员确定了早期复发患者的特征,并与一年后复发的患者进行了比较:结果:分别有 159 名和 85 名患者因 LARC 和 LRRC 而接受了盆腔开腹手术。其中,LARC 和 LRRC 组分别有 61 例(38.3%)和 74 例(87.1%)复发。就 LARC 而言,18 名患者出现了早期失败。值得期待的是,这些患者的边缘阳性率(R1)较高(50% 对其余 141 例患者中的 21%,∗p = 0.04)。有趣的是,早期失败还与更多的基因突变(33% 对 22%)、壁外静脉侵犯(32% 对 24%)、淋巴管侵犯(38% 对 22%)以及其他不良组织病理学特征有关,包括分化不良、标志环和/或粘液性疾病(38% 对 21%)。与其他患者相比,早期失败组的中位生存期和3年总生存期(OS)分别为96个月对30个月,35%对73%(∗p = 0.003)。LRRC 组群中有 18 例早期失败。同样,早期失败组中边缘阳性的患者更多(55% 对 39%,∗p = 0.02)。早期失败组还伴有壁外静脉侵犯(38% 对 23%)和不良组织病理学特征(55% 对 28%)。与非早期失败组相比,早期失败组的中位生存期和3年总生存期(OS)分别为15个月对0个月,17%对68%(∗p=结论:根据肿瘤特征定制治疗策略在晚期直肠癌的治疗中越来越重要。需要多中心数据来验证这些发现,这将对患者咨询和结果预期产生深远影响。
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来源期刊
CiteScore
4.40
自引率
0.00%
发文量
158
审稿时长
6-12 weeks
期刊介绍: Since its establishment in 2003, The Surgeon has established itself as one of the leading multidisciplinary surgical titles, both in print and online. The Surgeon is published for the worldwide surgical and dental communities. The goal of the Journal is to achieve wider national and international recognition, through a commitment to excellence in original research. In addition, both Colleges see the Journal as an important educational service, and consequently there is a particular focus on post-graduate development. Much of our educational role will continue to be achieved through publishing expanded review articles by leaders in their field. Articles in related areas to surgery and dentistry, such as healthcare management and education, are also welcomed. We aim to educate, entertain, give insight into new surgical techniques and technology, and provide a forum for debate and discussion.
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