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Pelvic exenteration for rectal cancer: a systematic review
Timothy X Yang1, David L Morris, Terence C Chua
1Hepatobiliary and Surgical Oncology Unit, UNSW Department of Surgery, St George Hospital, Systematic Review Unit, The Collaborative Research (CORE) Group, Kogarah, New South Wales, Sydney, Australia.
Pelvic exenteration offers potential cure for advanced rectal cancer, but carries significant risks. Survival outcomes, though potentially favorable, must be weighed against high complication and mortality rates in this systematic review.
Area of Science:
- Oncology
- Surgical Oncology
- Gastrointestinal Surgery
Background:
- Pelvic exenteration is a critical treatment for advanced primary or recurrent rectal cancer.
- This procedure aims for curative intent in complex cases.
- Rectal cancer at advanced stages presents significant therapeutic challenges.
Purpose of the Study:
- To systematically review clinical and oncological outcomes of pelvic exenteration.
- To evaluate survival rates, recurrence, complications, and mortality.
- To synthesize current evidence for advanced and recurrent rectal cancer patients.
Main Methods:
- Systematic literature search of PubMed, Medline, and Cochrane Library (2000-2012).
- Inclusion of prospective and retrospective studies on pelvic exenteration for rectal cancer.
- Analysis of oncological (survival, recurrence) and clinical (complications, mortality) outcomes.
Main Results:
- 23 studies with 1049 patients were reviewed.
- Complication rates varied widely (median 57%), with perioperative mortality at a median of 2.2%.
- Local recurrence rates were a median of 22%, and median survival ranged from 24 to 35.5 months.
Conclusions:
- The review highlights significant risks and complications associated with pelvic exenteration.
- Despite risks, potentially favorable survival outcomes justify its use when other options are limited.
- Limitations include small sample sizes and heterogeneity in reported data.
