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2017 ; 9
(5
): 218-227
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gab.com Text
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English Wikipedia
Critical evaluation of contemporary management in a new Pelvic Exenteration Unit:
The first 25 consecutive cases
#MMPMID28567186
Chew MH
; Yeh YT
; Toh EL
; Sumarli SA
; Chew GK
; Lee LS
; Tan MH
; Hennedige TP
; Ng SY
; Lee SK
; Chong TT
; Abdullah HR
; Goh TLH
; Rasheed MZ
; Tan KC
; Tang CL
World J Gastrointest Oncol
2017[May]; 9
(5
): 218-227
PMID28567186
show ga
AIM: To critically appraise short-term outcomes in patients treated in a new
Pelvic Exenteration (PE) Unit. METHODS: This retrospective observational study
was conducted by analysing prospectively collected data for the first 25 patients
(16 males, 9 females) who underwent PE for advanced pelvic tumours in our PE Unit
between January 2012 and October 2016. Data evaluated included age,
co-morbidities, American Society of Anesthesiologists (ASA) score, Eastern
Cooperative Oncology Group (ECOG) status, preoperative adjuvant treatment,
intra-operative blood loss, procedural duration, perioperative adverse event,
lengths of intensive care unit (ICU) stay and hospital stay, and oncological
outcome. Quantitative data were summarized as percentage or median and range, and
statistically assessed by the ?(2) test or Fisher's exact test, as applicable.
RESULTS: All 25 patients received comprehensive preoperative assessment via our
dedicated multidisciplinary team approach. Long-course neoadjuvant
chemoradiotherapy was provided, if indicated. The median age of the patients was
61.9-year-old. The median ASA and ECOG scores were 2 and 0, respectively. The
indications for PE were locally invasive rectal adenocarcinoma (n = 13), advanced
colonic adenocarcinoma (n = 5), recurrent cervical carcinoma (n = 3) and
malignant sacral chordoma (n = 3). The procedures comprised 10 total PEs, 4
anterior PEs, 7 posterior PEs and 4 isolated lateral PEs. The median follow-up
period was 17.6 mo. The median operative time was 11.5 h. The median volume of
blood loss was 3306 mL, and the median volume of red cell transfusion was 1475
mL. The median lengths of ICU stay and of hospital stay were 1 d and 21 d,
respectively. There was no case of mortality related to surgery. There were a
total of 20 surgical morbidities, which occurred in 12 patients. The majority of
the complications were grade 2 Clavien-Dindo. Only 2 patients experienced grade 3
Clavien-Dindo complications, and both required procedural interventions. One
patient experienced grade 4a Clavien-Dindo complication, requiring temporary
renal dialysis without long-term disability. The R0 resection rate was 64%. There
were 7 post-exenteration recurrences during the follow-up period. No
statistically significant relationship was found among histological origin of
tumour, microscopic resection margin status and postoperative recurrence (P =
0.67). Four patients died from sequelae of recurrent disease during follow-up.
CONCLUSION: By utilizing modern assessment and surgical techniques, our PE Unit
can manage complex pelvic cancers with acceptable morbidities, zero-rate
mortality and equivalent oncologic outcomes.