Outcomes Post Beyond Total Mesorectal Excision Plane Resections Following Setting up Complex Colorectal Cancer...

Area of Science:

• Surgical Oncology
• Colorectal Surgery
• Oncology

Background:

• Validating the feasibility of a hub-and-spoke model for pelvic exenteration (PE) surgery.
• Assessing patient outcomes within this model in a district general hospital setting.

Purpose of the Study:

• To evaluate the efficacy and safety of a hub-and-spoke model for pelvic exenteration.
• To determine if a district general hospital can achieve comparable outcomes to specialized centers.

Main Methods:

• Retrospective analysis of 67 patients undergoing pelvic exenteration between October 2017 and December 2023.
• Descriptive statistics and Kaplan-Meier survival analysis were utilized.
• Surgical approaches included open, laparoscopic, and robotic techniques.

Main Results:

• The majority of cases (91.04%) were for locally advanced colorectal cancer.
• Negative margins (R0 resection) were achieved in 85.12% of curative intent surgeries.
• Major complications (Clavien-Dindo III-IV) occurred in 35.82% of patients, with no mortalities.
• Two-year overall survival was 85.31% and disease-free survival was 77.0.36%.

Conclusions:

• A hub-and-spoke pelvic exenteration service can be successfully implemented in a district general hospital.
• This model, with adequate specialist support, can yield oncological and survival outcomes comparable to established centers.
• The study supports the decentralization of complex cancer surgeries with appropriate resource allocation.