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Impact of Intraoperative Decision-Making on Pathological Margin Status in Patients Undergoing Pelvic Exenteration for
Nargus Ebrahimi1,2, Kilian G M Brown1,2,3,4, Kheng-Seong Ng1,2,3,4,5
1Department of Colorectal Surgery, Royal Prince Alfred Hospital, Sydney, Australia.
Diseases of the Colon and Rectum
|February 21, 2024
Summary
Intraoperative changes during pelvic exenteration for recurrent rectal cancer are common, often leading to more extensive surgeries. These adjustments in the operative plan can contribute to achieving clear R0 resection margins in specialized centers.
Area of Science:
- Surgical Oncology
- Rectal Cancer Treatment
- Pelvic Exenteration
Background:
- Preoperative planning for pelvic exenteration relies on multidisciplinary assessment of tumor invasion via imaging.
- Intraoperative findings can necessitate modifications to the surgical plan and extent of resection.
Purpose of the Study:
- To determine the frequency and scope of intraoperative deviations from the planned resection during pelvic exenteration for locally recurrent rectal cancer.
- To assess whether these deviations resulted in more or less radical resections.
Main Methods:
- Retrospective observational study conducted at a high-volume pelvic exenteration center.
- Analysis of 136 patients who underwent pelvic exenteration for locally recurrent rectal cancer between January 2015 and December 2020.
- Evaluation of intraoperative changes to the planned resection extent and their impact on R0 resection rates.
Main Results:
- 40% of patients (49/124) experienced changes to their operative plan.
- Most changes were major (61%) and led to more radical resections (82%).
- Intraoperative modifications were associated with R0 resection margins in 81% of all patients.
Conclusions:
- Intraoperative deviations from the surgical plan are frequent in pelvic exenteration for recurrent rectal cancer.
- These changes commonly result in more radical resections, potentially improving R0 resection rates in specialized centers.
- Findings may have limited generalizability to non-specialist units.
