Yıl: 2021 Cilt: 31 Sayı: 1 Sayfa Aralığı: 20 - 24 Metin Dili: İngilizce DOI: 10.4274/tjcd.galenos.2020.2020-8-1 İndeks Tarihi: 21-05-2022

Pelvic Exenteration for Recurrent Rectal Cancer: A Single Institution Experience

Öz:
Aim: Rectal cancer is an important cause of cancer-related deaths worldwide (1-2). Although rectal cancers can be diagnosed earlier nowadays due to the development of screening programmes, 18% of patients have a locally advanced stage at the time of diagnosis (3). Despite the improvements in total mesorectal excision and oncological treatments, the locoregional recurrence rates vary between 6-10% in rectal cancer patients (4-5). Method: The data of patients who underwent pelvic exenteration for recurrent rectal cancer in our clinic between January 2015 and December 2019 were retrospectively analysed. Results: It was found that the patients with lymphovascular invasion (LVI) and perineural invasion (PNI) showed statistically poor survival rates (p=0.038/0.022). Two of the patients had a positive surgical margin and two others had a positive radial margin. There was no statistically significant difference between surgical margin positivity and prognosis (p>0.05). The mean number of metastatic lymph nodes was 4.0 (0-12), and the total number of lymph nodes was 12.35 (2-27). There was no statistically significant difference between patients with lymph node metastasis in terms of survival (p=0.079). Seven of the patients (41.1%) received systemic treatment before the surgery. It was statistically determined that the patients who received this treatment showed better survival rates (p=0.045). Conclusion: It was found that pelvic exenteration had a positive effect on survival and local recurrence in recurrent rectal cancer, and that neoadjuvant therapy increased survival rates.
Anahtar Kelime:

Rekürren Rektal Kanserlerde Pelvik Ekzantrasyon: Tek Merkez Deneyimi

Öz:
Amaç: Rektal kanser tüm dünyada kansere bağlı ölümlerin önemli bir nedenidir (1-2). Günümüzde gelişen tarama programları ile birlikte rektal kanserlere daha erken tanı konulabilse de tanı anında hastaların %18’i lokal ileri evrededir (3). Total mezorektal eksizyon ve onkolojik tedavilerdeki gelişmelere rağmen rektum kanserli hastalarada lokorejyonel rekurrens oranları %6-10 arasında değişmektedir (4-5). Yöntem: Kliniğimizde Ocak 2015-Aralık 2019 tarihleri arasında nüks rektum kanseri nedeniyle pelvik ekzantrasyon yapılan hastaların verileri retrospektif olarak inceledi. Bulgular: Patoloji raporları incelendiğinde hastaların 10’unda (%58,8) lenfovasküler invazyon, 10’unda (%58,8) perinöral invazyon vardı. lenfovasküler invazyon ve perinöral invazyon olan hastaların istatistiksel olarak kötü sağkalım gösterdikleri saptanmıştır (p=0,038/0,022). Hastaların 2’sinde cerrahi sınır pozitif gelmiş olup, 2’si de radyal sınır pozitifliğiydi. Cerrahi sınır pozitifliği ile prognoz arasında istatistiksel olarak anlamlı fark yoktu (p>0,05). Metastatik lenf nodu sayısı ortalama 4,0 (0-12), toplam lenf nodu sayısı ortalama 12,35 (2-27) olarak bulunmuştur. Lenf nodu metastazı olan hastalarda sağkalım açısından istatistiksel olarak fark bulunmamıştır (p=0,079). Hastaların 7’si (%41,1) operasyon öncesi sistemik tedavi almıştır. Sistemik tedavi alan hastaların daha iyi sağkalım gösterdiği istatistiksel olarak saptanmıştır (p=0,045). Sonuç: Nüks rektum kanserinde pelvik ekzantrasyon ve neoadjuvan tedavinin sağ kalımı artırdığı lokal nüksü azalttığı gözlenmiştir.
Anahtar Kelime:

Belge Türü: Makale Makale Türü: Araştırma Makalesi Erişim Türü: Erişime Açık
  • 1. Canadian Cancer Society/NationalCancer Institute of Canada. Canadian Cancer Statistics 2009, Toronto, Canada, 2009. Available from: https:// www.cancer.ca/en/cancer-information/cancer-101/canadian-cancerstatistics-publication/past-editions-canadian-cancer-statistics/~/ media/98DB59DCE6EE45ADABFE978EC3DBD4AD.ashx
  • 2. NationalCancer Information Center. Cancerinformation service [Internet]. Goyang (KR): NationalCancer Information Center; c2011 [cited 2012 Jun 5]. Availablefrom: http://www.cancer. go.kr/ncic/cics_f/01/014/index. html.
  • 3. O’Connell JB, Maggard MA, Liu JH, Liu JH, Etzioni DA, Ko CY. Are survival rates different for young and older patients with rectal cancer? Dis Colon Rectum 2004;47:2064-2069.
  • 4. Bakx R, Visser O, Josso J, Meijer S, Slors JF, vanLanschot JJ. Man¬agement of recurrentrectalcancer: a populationbasedstudy in greater Amsterdam. World J Gastroenterol 2008;14:6018-6023.
  • 5. Sebag-Montefiore D, Stephens RJ, Steele R, Monson J, Grieve R, Khanna S, Quirke P, Couture J, de Metz C, Myint AS, Bessell E, Griffiths G, Thompson LC, Parmar M. Preoperative radiotherapy versus selective post¬operative chemoradiotherapy in patients with rectal cancer (MRC CR07 and NCICCTG C016): a multicentre, randomisedtrial. Lancet 2009;373:811-820.
  • 6. Pilipshen SJ, Heilweil M, Quan SH, Sternberg SS, Enker WE. Pat¬terns of pelvic recurrence following definitive resections of rectal cancer. Cancer 1984;53:1354-1362.
  • 7. McDermott FT, Hughes ES, Pihl E, Johnson WR, Price AB. Local recurrence after potentially curative resection forrectal cancer in a series of 1008 patients. Br J Surg 1985;72:34-37.
  • 8. Ito Y, Ohtsu A, Ishikura S, Boku N, Nihei K, Ogino T, Ikeda H. Effi¬cacy of chemoradiotherapy on painrelief in patients with intra¬pelvic recurrence of rectal cancer. Jpn J Clin Oncol 2003;33:180-185.
  • 9. Brunschwig A. Complete excision of pelvicviscera for advancedc arcinoma. Cancer 1948;1:177-183.
  • 10. Boey J, Wong J, Ong GB. Pelvic exenteration for locally advanced colorectal carcinoma. Ann Surg 1982;195:513-518.
  • 11. Lopez MJ, Kraybill WG, Downey RS, Johnston WD, Bricker EM. Exenterative surgery for locally advanced rectosigmoid cancers. Is it worthwhile? Surgery1987;102:644-651.
  • 12. Jimenez RE, Shoup M, Cohen AM, Paty PB, Guillem J, Wong WD. Contemporary outcomes of total pelvic exenteration in treatment of colorectal cancer. Dis Colon Rectum 2003;46:1619-1625.
  • 13. Law WL, Chu KW, Choi HK. Total pelvic exenteration for locally advanced rectal cancer. J Am Coll Surg 2000;190:78-83.
  • 14. Palmer G, Martling A, Cedermark B, Holm T. A population-based study on the management and outcome in patients with locally recurrent rectal cancer. Ann Surg Oncol 2007;14:447-454.
  • 15. Pawlik TM, Skibber JM, Rodriguez-Bigas MA. Pelvic exentera¬tion for advanced pelvic malignancies. Ann Surg Oncol 2006;13:612-623.
  • 16. Mirnezami AH, Sagar PM, Kavanagh D, Witherspoon P, Lee P, Winter D. Clinical algorithms for the surgical management of lo¬cally recurrent rectal cancer. Dis Colon Rectum 2010;53:1248-1257.
  • 17. Moriya Y, Akasu T, Fujita S, Yamamoto S. Total pelvic exenteration with distal sacrectomy for fixed recurrent rectal cancer inthe pel¬vis. Dis Colon Rectum. 2004;47:2047-2053.
  • 18. Heriot AG, Tekkis PP, Darzi A, Mackay J. Surgery for local recurrence of rectal cancer. Colorectal Dis 2006;8:733-747.
  • 19. Domests, Colquhoun Ph, Taylor B, Izawa JI, House AA, Luke PPW. Total pelvic exenteration for rectal cancer: out come sand prognostic factors. Can J Surg 2011;54:387-393.
  • 20. Ferenschild FT, Vermaas M, Verhoef C, Ansink AC, Kirkels WJ, Eggermont AMM, de Wilt JHW. Total pelvic exenteration for primary and recurrent malignancies. World J Surg 2009;33:1502-1508.
  • 21. Hsu TW, Chiang FF, Chen MC, Wang HM. Pelvic exenteration for men with locally advanced rectal cancer: a morbidity analysis of complicated cases. Asian J Surg 2011;34:115-120.
  • 22. Bernstein TE, Endreseth BH, Romundstad P, Wibe A; Norwegian Colorectal Cancer Group. Circumferential resection margin as a prognostic factor in rectal cancer. Br J Surg 2009;96:1348-1357.
  • 23. Kelly ME, Winter DC; Pelv Ex Collaborative. Surgical and survival outcomes following pelvic exenteration for locally advanced primary rectal cancer: results from an international collaboration. Ann Surg 2019;269: 315-321.
  • 24. Kakuda JT, Lamont JP, Chu DZ, Paz IB. The role of pelvic exenteration in the management of recurrent rectal cancer. Am J Surg 2003;186:660-664.
  • 25. Ishiguro S, Akasu T, Fujita S, Yamamoto S, Kusters M, Moriya Y. Pelvic exenteration for clinical T4 rectal cancer: oncologic outcome in 93 patients at a single institution over a 30-year period. Surgery 2009;145:189-195.
  • 26. Yang T, Morris D, Chua T. Pelvic exenteration for rectal cancer: a systematic review. Dis Colon Rectum 2013;56:519–531.
  • 27. Hida J, Yasutomi M, Maruyama T, Akihiro Nakajima M.D., Uchida T, Wakano T, Tokoro T, Fujimoto K. Results from pelvic exenteration for locally advanced colorectal cancer with lymphnode metastases. Dis Colon Rectum 1998;41:165-168.
  • 28. Lehnert T, Methner M, Pollok A, Schaible A, Hinz U, Herfarth C. Multivisceral resection for locally advanced primary colon and rectal cancer: an analysis of prognostic factors in 201 patients. Ann Surg 2002;235:217-225.
APA Culcu S, Yüksel C, Kültüroğlu M, Göksel F, Güner E, aksel b, TILIÇ L (2021). Pelvic Exenteration for Recurrent Rectal Cancer: A Single Institution Experience. , 20 - 24. 10.4274/tjcd.galenos.2020.2020-8-1
Chicago Culcu Serdar,Yüksel Cemil,Kültüroğlu Mahmut Onur,Göksel Fatih,Güner Eda,aksel bulent,TILIÇ Lütfi Dogan Pelvic Exenteration for Recurrent Rectal Cancer: A Single Institution Experience. (2021): 20 - 24. 10.4274/tjcd.galenos.2020.2020-8-1
MLA Culcu Serdar,Yüksel Cemil,Kültüroğlu Mahmut Onur,Göksel Fatih,Güner Eda,aksel bulent,TILIÇ Lütfi Dogan Pelvic Exenteration for Recurrent Rectal Cancer: A Single Institution Experience. , 2021, ss.20 - 24. 10.4274/tjcd.galenos.2020.2020-8-1
AMA Culcu S,Yüksel C,Kültüroğlu M,Göksel F,Güner E,aksel b,TILIÇ L Pelvic Exenteration for Recurrent Rectal Cancer: A Single Institution Experience. . 2021; 20 - 24. 10.4274/tjcd.galenos.2020.2020-8-1
Vancouver Culcu S,Yüksel C,Kültüroğlu M,Göksel F,Güner E,aksel b,TILIÇ L Pelvic Exenteration for Recurrent Rectal Cancer: A Single Institution Experience. . 2021; 20 - 24. 10.4274/tjcd.galenos.2020.2020-8-1
IEEE Culcu S,Yüksel C,Kültüroğlu M,Göksel F,Güner E,aksel b,TILIÇ L "Pelvic Exenteration for Recurrent Rectal Cancer: A Single Institution Experience." , ss.20 - 24, 2021. 10.4274/tjcd.galenos.2020.2020-8-1
ISNAD Culcu, Serdar vd. "Pelvic Exenteration for Recurrent Rectal Cancer: A Single Institution Experience". (2021), 20-24. https://doi.org/10.4274/tjcd.galenos.2020.2020-8-1
APA Culcu S, Yüksel C, Kültüroğlu M, Göksel F, Güner E, aksel b, TILIÇ L (2021). Pelvic Exenteration for Recurrent Rectal Cancer: A Single Institution Experience. Türk Kolon ve Rektum Hastalıkları Dergisi, 31(1), 20 - 24. 10.4274/tjcd.galenos.2020.2020-8-1
Chicago Culcu Serdar,Yüksel Cemil,Kültüroğlu Mahmut Onur,Göksel Fatih,Güner Eda,aksel bulent,TILIÇ Lütfi Dogan Pelvic Exenteration for Recurrent Rectal Cancer: A Single Institution Experience. Türk Kolon ve Rektum Hastalıkları Dergisi 31, no.1 (2021): 20 - 24. 10.4274/tjcd.galenos.2020.2020-8-1
MLA Culcu Serdar,Yüksel Cemil,Kültüroğlu Mahmut Onur,Göksel Fatih,Güner Eda,aksel bulent,TILIÇ Lütfi Dogan Pelvic Exenteration for Recurrent Rectal Cancer: A Single Institution Experience. Türk Kolon ve Rektum Hastalıkları Dergisi, vol.31, no.1, 2021, ss.20 - 24. 10.4274/tjcd.galenos.2020.2020-8-1
AMA Culcu S,Yüksel C,Kültüroğlu M,Göksel F,Güner E,aksel b,TILIÇ L Pelvic Exenteration for Recurrent Rectal Cancer: A Single Institution Experience. Türk Kolon ve Rektum Hastalıkları Dergisi. 2021; 31(1): 20 - 24. 10.4274/tjcd.galenos.2020.2020-8-1
Vancouver Culcu S,Yüksel C,Kültüroğlu M,Göksel F,Güner E,aksel b,TILIÇ L Pelvic Exenteration for Recurrent Rectal Cancer: A Single Institution Experience. Türk Kolon ve Rektum Hastalıkları Dergisi. 2021; 31(1): 20 - 24. 10.4274/tjcd.galenos.2020.2020-8-1
IEEE Culcu S,Yüksel C,Kültüroğlu M,Göksel F,Güner E,aksel b,TILIÇ L "Pelvic Exenteration for Recurrent Rectal Cancer: A Single Institution Experience." Türk Kolon ve Rektum Hastalıkları Dergisi, 31, ss.20 - 24, 2021. 10.4274/tjcd.galenos.2020.2020-8-1
ISNAD Culcu, Serdar vd. "Pelvic Exenteration for Recurrent Rectal Cancer: A Single Institution Experience". Türk Kolon ve Rektum Hastalıkları Dergisi 31/1 (2021), 20-24. https://doi.org/10.4274/tjcd.galenos.2020.2020-8-1