Abstract
BackgroundPelvic exenteration (PE) is the preferred treatment available for selected patients diagnosed with locally advanced or recurrent cancer confined to the pelvis. Currently, the majority of the literature reports only on short‐term survival and quality‐of‐life (QoL) outcomes. The aim of this prospective cohort study was to describe long‐term survival and QoL outcomes following PE.MethodsThis was a cohort study of consecutive patients undergoing PE from 1994 to 2016 at a major teaching hospital in Sydney, Australia. From 2008, consenting patients were also included in a prospective QoL study. Main outcomes were long‐term survival and QoL assessed with SF‐36® and FACT‐C questionnaires. Survival was estimated using the Kaplan–Meier method.ResultsSome 515 patients underwent PE for locally advanced or recurrent cancer. The cumulative 5‐ and 10‐year overall survival rates were 48·6 and 37·8 per cent respectively. The survival estimates were significantly higher for patients with advanced primary rectal cancer (P = 0·045) and those in whom a clear resection margin was achieved (P < 0·001). Some 287 patients were enrolled into the QoL study. Response rates at baseline, 6 months and 5 years were 92·0, 70·0 and 33 per cent respectively. Patients had recovered to their preoperative QoL status by 6 months and, among survivors, QoL remained essentially unchanged during the 5‐year follow‐up.ConclusionPatients who underwent PE owing to advanced primary rectal cancer or achieved a clear resection margin had a greater chance of survival. Overall, QoL returned to baseline within 6 months after surgery.
Highlights
For patients with locally advanced or recurrent cancer confined to the pelvis, including rectal, gynaecological origin and urological cancer, complete resection with clear margins (R0 resection) provides the best chance of survival[1]
Patients presenting with advanced primary rectal cancer had better 5- and 10-year overall survival rates (60⋅1 and 46⋅1 per cent respectively) compared with patients with recurrent rectal cancer
QoL was restored to preoperative status within the first 6 months and remained essentially unchanged for up to 5 years after surgery
Summary
For patients with locally advanced or recurrent cancer confined to the pelvis, including rectal, gynaecological origin and urological cancer, complete resection with clear margins (R0 resection) provides the best chance of survival[1]. Surgical techniques and postoperative management have moved PE from a palliative to a curative procedure in appropriately selected patients[3] This is, at the expense of high complication rates and prolonged recovery after surgery[4,5]. An overall 5-year survival rate of between 30 and 60 per cent has been reported, with QoL outcomes returning to preoperative levels in the first 6–9 months after surgery[7,8]. The majority of the literature reports only on short-term survival and quality-of-life (QoL) outcomes The aim of this prospective cohort study was to describe long-term survival and QoL outcomes following PE. Conclusion: Patients who underwent PE owing to advanced primary rectal cancer or achieved a clear resection margin had a greater chance of survival. QoL returned to baseline within 6 months after surgery
Sign-in/Register to view highlights & summary Sign-in/Register to access full text options 
Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have
Schedule a callDisclaimer: All third-party content on this website/platform is and will remain the property of their respective owners and is provided on "as is" basis without any warranties, express or implied. Use of third-party content does not indicate any affiliation, sponsorship with or endorsement by them. Any references to third-party content is to identify the corresponding services and shall be considered fair use under The CopyrightLaw.
