Surgical and Survival Outcomes Following Pelvic Exenteration for Locally Advanced Primary Rectal Cancer Results From an International Collaboration
Surgical and Survival Outcomes Following Pelvic Exenteration for Locally Advanced Primary Rectal Cancer Results From an International Collaboration
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DOI：
10.1097/sla.0000000000002528
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发表时间：
2019-02-01
影响因子：
9
通讯作者：
Winter, D. C.
中科院分区：
文献类型：
--
作者：
Kelly, M. E.;Glynn, R.;Winter, D. C.
目的：本研究的目的是分析国际合作的数据，并确定预后指标，为临床决策和实践提供有关盆腔廓清术在局部晚期原发性直肠癌 (LARC) 中的作用的信息。背景：随着国家筛查计划的改进，患有 LARC 的患者越来越少。尽管如此，仍有部分患者需要进行盆腔廓清术。迄今为止，大多数结果数据均来自单中心系列。方法：收集了 2004 年至 2014 年间 14 个国家因 LARC 接受盆腔廓清术的患者的匿名数据。主要终点是总生存期。使用多变量分析评估切除边缘、淋巴结状态、骨切除和新辅助治疗（切除前）的使用对生存的影响。 结果：1291 名患者中，778 名患者（60.3%）为男性，中位年龄（范围）为 63（18-90）岁； 78.1%接受新辅助治疗。 8.2% 的患者 (n = 106) 进行了整体骨切除，22.6% (n = 292) 进行了骨切除联合皮瓣重建。 79.9% 的患者实现了负切除边缘（R0 切除）。术后30天死亡率为1.5%。R0、R1和R2切除后的中位总生存期分别为43、21和10个月（P < 0.001），3年生存率分别为56.4%、29.6%和8.1%（P < 0.001）； 37.8%的患者出现一种或多种主要并发症。新辅助治疗增加了 30 天发病的风险 (P < 0.012)。多变量分析确定切除边缘和淋巴结状态是总体生存的重要决定因素（高龄除外）。结论：达到负切除边缘 (R0) 是生存的关键。新辅助治疗可提高生存率；然而，这样做会增加术后发病的风险。
Objective: The aim of the study was to analyze data from an international collaboration, and ascertain prognostic indicators that inform clinical decision-making and practices regarding the role of pelvic exenteration for locally advanced primary rectal cancer (LARC).Background: With improved national screening programs fewer patients present with LARC. Despite this, select cohorts of patients require pelvic exenteration. To date, the majority of outcome data are from single-center series.Methods: Anonymized data from 14 countries on patients who had pelvic exenteration for LARC between 2004 and 2014 were accumulated. The primary endpoint was overall survival. The impact of resection margin, nodal status, bone resection, and use of neoadjuvant therapy (before exenteration) on survival was evaluated using multivariable analysis.Results: Of 1291 patients, 778 (60.3%) were male with a median (range) age of 63 (18-90) years; 78.1% received neoadjuvant therapy. Bone resection en bloc was performed in 8.2% of patients (n = 106), and 22.6% (n = 292) had resection combined with flap reconstruction. Negative resection margin (R0 resection) was achieved in 79.9%. The 30-day postoperative mortality was 1.5%.The median overall survival following R0, R1, and R2 resection was 43, 21, and 10 months (P < 0.001) with a 3-year survival of 56.4%, 29.6%, and 8.1%, respectively (P < 0.001); 37.8% of patients experienced one or more major complication. Neoadjuvant therapy increased the risk of 30-day morbidity (P < 0.012). Multivariable analysis identified resection margin and nodal status as significant determinants of overall survival (other than advanced age).Conclusions: Attainment of negative resection margins (R0) is the key to survival. Neoadjuvant therapy may improve survival; however, it does so at the increased risk of postoperative morbidity.