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Michael J Solomon - One of the best experts on this subject based on the ideXlab platform.
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outcomes of Pelvic Exenteration for locally advanced primary rectal cancer overall survival and quality of life
Ejso, 2016Co-Authors: A J Quyn, Kirk K S Austin, Jane M Young, Tim Badgeryparker, Lindy Masya, Rachael Roberts, Michael J SolomonAbstract:Abstract Introduction Radical surgery with Pelvic Exenteration offers the only potential for cure in patients with locally advanced primary rectal cancer. This study describes the clinical and patient-reported quality of life outcomes over 12 months for patients having Pelvic Exenteration for locally advanced primary rectal cancer at a specialised centre for Pelvic Exenteration. Methods Clinical data of consecutive patients undergoing Pelvic Exenteration for locally advanced primary rectal cancer and patient-reported outcomes were collected at baseline, hospital discharge and at 1, 3, 6, 9 and 12 months. Patient-reported outcomes included cancer-specific quality of life (QoL) and physical and mental health status. Quality of life trajectories were modelled over the 12 months from the date of surgery using linear mixed models. Results 104 patients with locally advanced rectal cancer underwent Pelvic Exenteration at Royal Prince Alfred Hospital, Sydney, between December 1994 and October 2014. Complete soft tissue Exenteration was performed in 38%. A clear margin was obtained in 86% with a 62% overall five-year survival. QoL outcome questionnaires were completed by 62% of patient cohort. The average FACT-C score returned to pre-surgery QoL by 2 months after surgery, and the average QoL continued to increase slowly over the 12 months. Conclusion Our results support an aggressive approach to advanced primary rectal cancer and lend weight to the oncological role of Pelvic Exenteration for this group of patients. Quality of life improves rapidly after Pelvic Exenteration for locally advanced primary rectal cancer and continues to improve over the first year.
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lateral Pelvic compartment excision during Pelvic Exenteration
British Journal of Surgery, 2015Co-Authors: Michael J Solomon, Kirk K S Austin, Kilian G M Brown, Lindy MasyaAbstract:Background Involvement of the lateral compartment remains a relative or absolute contraindication to Pelvic Exenteration in most units. Initial experience with Exenteration in the authors' unit produced a 21 per cent clear margin rate (R0), which improved to 53 per cent by adopting a novel technique for en bloc resection of the iliac vessels and other side-wall structures. The objective of this study was to report morbidity and oncological outcomes in consecutive Exenterations involving the lateral compartment. Methods Patients undergoing Pelvic Exenteration between 1994 and 2014 were eligible for review. Results Two hundred consecutive patients who had en bloc resection of the lateral compartment were included. R0 resection was achieved in 66·5 per cent of 197 patients undergoing surgery for cancer and 68·9 per cent of planned curative resections. For patients with colorectal cancer, a clear resection margin was associated with a significant overall survival benefit (P = 0·030). Median overall and disease-free survival in this group was 41 and 27 months respectively. Overall 1-, 3- and 5-year survival rates were 86, 46 and 35 per cent respectively. No predictors of survival were identified on univariable analysis other than margin status and operative intent. Excision of the common or external iliac vessels or sciatic nerve did not confer a survival disadvantage. Conclusion The continuing evolution of radical Pelvic Exenteration techniques has seen an improvement in R0 margin status from 21 to 66·5 per cent over a 20-year interval by routine adoption of a more lateral anatomical plane. Five-year overall survival rates are comparable with those for more centrally based tumours.
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survival after Pelvic Exenteration for t4 rectal cancer
British Journal of Surgery, 2015Co-Authors: Miranda Kusters, Kirk K S Austin, Michael J Solomon, Grard A P Nieuwenhuijzen, H J T RuttenAbstract:Background The purpose of this study was to analyse retrospectively the pooled results after Pelvic Exenteration for locally advanced T4 rectal cancer. Historically, patients with T4 rectal cancers requiring Pelvic Exenteration have been offered only palliative surgery or no operation. Methods The basic treatment principle was preoperative (chemo)radiotherapy, radical surgery and, in some patients, adjuvant chemotherapy. Risk factors for local recurrence, distant metastases and overall survival were studied in univariable and multivariable analyses. Results Ninety-five patients with T4 rectal cancer who underwent Pelvic Exenteration in two tertiary referral centres up to 2013 were studied. Clear margins (R0) were achieved in 87 per cent of patients. Adjuvant chemotherapy was administered in 33 per cent, independent of the resection margin, lymph node status and postoperative T category. The 5-year local recurrence rate was 17 per cent, with a distant metastasis rate of 16 per cent and overall survival rate of 62 per cent. In multivariable analysis the only factor associated with death was omission of adjuvant chemotherapy (P = 0·016). The effect of adjuvant chemotherapy was more pronounced in the elderly: patients aged over 70 years who had chemotherapy had a 5-year overall survival rate of 80 per cent, compared with 39 per cent of elderly patients who did not receive chemotherapy (P = 0·019). Conclusion Pelvic Exenteration led to an R0 resection rate of 87 per cent for T4 rectal cancer, giving good local control and overall survival comparable to population-based colorectal cancer survival rates. Adjuvant chemotherapy may improve overall survival further, even in the elderly.
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quality of life of survivors after Pelvic Exenteration for rectal cancer
Diseases of The Colon & Rectum, 2010Co-Authors: Kirk K S Austin, Jane M Young, Michael J SolomonAbstract:INTRODUCTION: There is little information about the impact of Pelvic Exenteration on patients' quality of life. This study aimed to measure quality of life for longer-term disease-free survivors after Pelvic Exenteration. METHODS: A retrospective review to identify patients who underwent Pelvic Exenteration for locally advanced primary or recurrent rectal cancer was performed. Telephone interviews to assess quality of life were performed using the Short Form 36 version 2 and Functional Assessment of Cancer Therapy-Colorectal instruments. Responses were compared with normative data from the general Australian population and patients with rectal cancer who underwent low anterior resection or abdominoperineal excision. RESULTS: Of 75 patients with rectal cancer, 44 were alive and 37 (84%) completed the quality-of-life assessment a median 47 months after Pelvic Exenteration. Functional Assessment of Cancer Therapy scores in the survivors were good (107) and comparable to those for patients who had a low anterior resection or abdominoperineal excision a median of 3 months previously (106). Although the physical component summary scale of the Short Form 36 was lower in Pelvic Exenteration patients (44.7) than for the Australian population, the mental component summary scale was high (53.5) and comparable. CONCLUSION: Despite the small sample, long-term quality of life in survivors of Pelvic Exenteration for rectal cancer is comparable to early results following primary rectal cancer resection and to mental but not physical norm-based population scores.
Kirk K S Austin - One of the best experts on this subject based on the ideXlab platform.
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outcomes of Pelvic Exenteration for locally advanced primary rectal cancer overall survival and quality of life
Ejso, 2016Co-Authors: A J Quyn, Kirk K S Austin, Jane M Young, Tim Badgeryparker, Lindy Masya, Rachael Roberts, Michael J SolomonAbstract:Abstract Introduction Radical surgery with Pelvic Exenteration offers the only potential for cure in patients with locally advanced primary rectal cancer. This study describes the clinical and patient-reported quality of life outcomes over 12 months for patients having Pelvic Exenteration for locally advanced primary rectal cancer at a specialised centre for Pelvic Exenteration. Methods Clinical data of consecutive patients undergoing Pelvic Exenteration for locally advanced primary rectal cancer and patient-reported outcomes were collected at baseline, hospital discharge and at 1, 3, 6, 9 and 12 months. Patient-reported outcomes included cancer-specific quality of life (QoL) and physical and mental health status. Quality of life trajectories were modelled over the 12 months from the date of surgery using linear mixed models. Results 104 patients with locally advanced rectal cancer underwent Pelvic Exenteration at Royal Prince Alfred Hospital, Sydney, between December 1994 and October 2014. Complete soft tissue Exenteration was performed in 38%. A clear margin was obtained in 86% with a 62% overall five-year survival. QoL outcome questionnaires were completed by 62% of patient cohort. The average FACT-C score returned to pre-surgery QoL by 2 months after surgery, and the average QoL continued to increase slowly over the 12 months. Conclusion Our results support an aggressive approach to advanced primary rectal cancer and lend weight to the oncological role of Pelvic Exenteration for this group of patients. Quality of life improves rapidly after Pelvic Exenteration for locally advanced primary rectal cancer and continues to improve over the first year.
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lateral Pelvic compartment excision during Pelvic Exenteration
British Journal of Surgery, 2015Co-Authors: Michael J Solomon, Kirk K S Austin, Kilian G M Brown, Lindy MasyaAbstract:Background Involvement of the lateral compartment remains a relative or absolute contraindication to Pelvic Exenteration in most units. Initial experience with Exenteration in the authors' unit produced a 21 per cent clear margin rate (R0), which improved to 53 per cent by adopting a novel technique for en bloc resection of the iliac vessels and other side-wall structures. The objective of this study was to report morbidity and oncological outcomes in consecutive Exenterations involving the lateral compartment. Methods Patients undergoing Pelvic Exenteration between 1994 and 2014 were eligible for review. Results Two hundred consecutive patients who had en bloc resection of the lateral compartment were included. R0 resection was achieved in 66·5 per cent of 197 patients undergoing surgery for cancer and 68·9 per cent of planned curative resections. For patients with colorectal cancer, a clear resection margin was associated with a significant overall survival benefit (P = 0·030). Median overall and disease-free survival in this group was 41 and 27 months respectively. Overall 1-, 3- and 5-year survival rates were 86, 46 and 35 per cent respectively. No predictors of survival were identified on univariable analysis other than margin status and operative intent. Excision of the common or external iliac vessels or sciatic nerve did not confer a survival disadvantage. Conclusion The continuing evolution of radical Pelvic Exenteration techniques has seen an improvement in R0 margin status from 21 to 66·5 per cent over a 20-year interval by routine adoption of a more lateral anatomical plane. Five-year overall survival rates are comparable with those for more centrally based tumours.
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survival after Pelvic Exenteration for t4 rectal cancer
British Journal of Surgery, 2015Co-Authors: Miranda Kusters, Kirk K S Austin, Michael J Solomon, Grard A P Nieuwenhuijzen, H J T RuttenAbstract:Background The purpose of this study was to analyse retrospectively the pooled results after Pelvic Exenteration for locally advanced T4 rectal cancer. Historically, patients with T4 rectal cancers requiring Pelvic Exenteration have been offered only palliative surgery or no operation. Methods The basic treatment principle was preoperative (chemo)radiotherapy, radical surgery and, in some patients, adjuvant chemotherapy. Risk factors for local recurrence, distant metastases and overall survival were studied in univariable and multivariable analyses. Results Ninety-five patients with T4 rectal cancer who underwent Pelvic Exenteration in two tertiary referral centres up to 2013 were studied. Clear margins (R0) were achieved in 87 per cent of patients. Adjuvant chemotherapy was administered in 33 per cent, independent of the resection margin, lymph node status and postoperative T category. The 5-year local recurrence rate was 17 per cent, with a distant metastasis rate of 16 per cent and overall survival rate of 62 per cent. In multivariable analysis the only factor associated with death was omission of adjuvant chemotherapy (P = 0·016). The effect of adjuvant chemotherapy was more pronounced in the elderly: patients aged over 70 years who had chemotherapy had a 5-year overall survival rate of 80 per cent, compared with 39 per cent of elderly patients who did not receive chemotherapy (P = 0·019). Conclusion Pelvic Exenteration led to an R0 resection rate of 87 per cent for T4 rectal cancer, giving good local control and overall survival comparable to population-based colorectal cancer survival rates. Adjuvant chemotherapy may improve overall survival further, even in the elderly.
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quality of life of survivors after Pelvic Exenteration for rectal cancer
Diseases of The Colon & Rectum, 2010Co-Authors: Kirk K S Austin, Jane M Young, Michael J SolomonAbstract:INTRODUCTION: There is little information about the impact of Pelvic Exenteration on patients' quality of life. This study aimed to measure quality of life for longer-term disease-free survivors after Pelvic Exenteration. METHODS: A retrospective review to identify patients who underwent Pelvic Exenteration for locally advanced primary or recurrent rectal cancer was performed. Telephone interviews to assess quality of life were performed using the Short Form 36 version 2 and Functional Assessment of Cancer Therapy-Colorectal instruments. Responses were compared with normative data from the general Australian population and patients with rectal cancer who underwent low anterior resection or abdominoperineal excision. RESULTS: Of 75 patients with rectal cancer, 44 were alive and 37 (84%) completed the quality-of-life assessment a median 47 months after Pelvic Exenteration. Functional Assessment of Cancer Therapy scores in the survivors were good (107) and comparable to those for patients who had a low anterior resection or abdominoperineal excision a median of 3 months previously (106). Although the physical component summary scale of the Short Form 36 was lower in Pelvic Exenteration patients (44.7) than for the Australian population, the mental component summary scale was high (53.5) and comparable. CONCLUSION: Despite the small sample, long-term quality of life in survivors of Pelvic Exenteration for rectal cancer is comparable to early results following primary rectal cancer resection and to mental but not physical norm-based population scores.
Gwenael Ferron - One of the best experts on this subject based on the ideXlab platform.
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laparoscopic anterior Pelvic Exenteration in 10 steps
Gynecologic Oncology, 2018Co-Authors: Carlos Martinezgomez, Martina Aida Angeles, Alejandra Martinez, Gwenael FerronAbstract:• Pelvic Exenteration is a salvage procedure for patients with advanced gynecological malignancies.
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laparoscopy assisted vaginal Pelvic Exenteration
Gynecologic Oncology, 2006Co-Authors: Gwenael Ferron, Benoit Letourneur, Pierre Martel, Denis Querleu, Michel SouliéAbstract:Abstract Objective. The aim of this study was to evaluate the feasibility, morbidity and survival outcome of laparoscopy-assisted vaginal Pelvic Exenteration. Methods. Since 2000, we have performed 5 cases of en-bloc Pelvic Exenteration combining a vaginal or perineal approach and laparoscopic approach. All patients had received previous Pelvic irradiation. One patient underwent a total type II Exenteration with ileal-loop diversion, an omental flap and a temporary colostomy. Two patients underwent a middle and posterior Exenteration: one was a type III Exenteration with perineal rectal resection and a gracilis myocutaneous flap; the second one was a type II Exenteration with a colorectal anastomosis and a vaginal reconstruction using a gluteal thigh flap. Two patients underwent a type I anterior and middle Exenteration with continent Miami pouch and vaginal reconstruction by omental cylinder. Results. Mean time of the procedure was 6 h (range: 4.5–9). Peroperative bleeding was less than 500 cm 3 . Two patients presented minor complications: a perineal abscess after perineal rectal resection and an abdominal wound abscess. Mean length of hospital stay was 27 days. Three patients are free of disease. Two patients presented groin metastasis. One patient died of disease after 8 months. Conclusion. Laparoscopic or laparoscopy-assisted vaginal Pelvic Exenteration followed by reconstruction is feasible with curative intent in selected patients.
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Laparoscopy-assisted vaginal Pelvic Exenteration
Gynecologic Oncology, 2006Co-Authors: Gwenael Ferron, Benoit Letourneur, Pierre Martel, Denis Querleu, Michel SouliéAbstract:Objective. The aim of this study was to evaluate the feasibility, morbidity and survival outcome of laparoscopy-assisted vaginal Pelvic Exenteration. Methods. Since 2000, we have performed 5 cases of en-bloc Pelvic Exenteration combining a vaginal or perineal approach and laparoscopic approach. All patients had received previous Pelvic irradiation. One patient underwent a total type II Exenteration with ileal-loop diversion, an omental flap and a temporary colostomy. Two patients underwent a middle and posterior Exenteration: one was a type III Exenteration with perineal rectal resection and a gracilis myocutaneous flap; the second one was a type II Exenteration with a colorectal anastomosis and a vaginal reconstruction using a gluteal thigh flap. Two patients underwent a type I anterior and middle Exenteration with continent Miami pouch and vaginal reconstruction by omental cylinder. Results. Mean time of the procedure was 6 h (range: 4.5-9). Peroperative bleeding was less than 500 cm3. Two patients presented minor complications: a perineal abscess after perineal rectal resection and an abdominal wound abscess. Mean length of hospital stay was 27 days. Three patients are free of disease. Two patients presented groin metastasis. One patient died of disease after 8 months. Conclusion. Laparoscopic or laparoscopy-assisted vaginal Pelvic Exenteration followed by reconstruction is feasible with curative intent in selected patients. © 2005 Elsevier Inc. All rights reserved.
Shigeo Ohki - One of the best experts on this subject based on the ideXlab platform.
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outcome of total Pelvic Exenteration for locally recurrent rectal cancer
Hepato-gastroenterology, 2003Co-Authors: Hiroshi Shimada, Shigeki Yamaguchi, Yasushi Ichikawa, Shigeo Ohki, Shouichi FujiiAbstract:BACKGROUND/AIMS: Local recurrence occurs in 10 to 30% of patients with rectal cancer following curative resection. However treatment of choice remains controversial. We assessed the results of total Pelvic Exenteration for locally recurrent cancer of the rectum retrospectively. METHODOLOGY: We reviewed medical charts of 45 patients with rectal cancer who underwent curative total Pelvic Exenteration for local recurrence. The cause of recurrence was classified into four groups: anastomotic, surgical cut-end, implantation, and lymphatic based on pathologic findings and computed tomography. Long-term survival was correlated with clinicopathologic variables. RESULTS: Postoperative morbidity was 77.8% and in-hospital death occurred in 13.3% of patients. The overall 5-year survival rate was 14.1%. The 5-year survival rates stratified according to the expectation of curability were 31.6% for absolutely curative resection, 7.8% for relatively curative resection, and 0% for non-curative resection. Multivariate analysis revealed that the disease-free interval was the only independent prognostic factor. There was no benefit from perioperative radiation or intraoperative continuous Pelvic peritoneal perfusion of the pelvis. CONCLUSIONS: Total Pelvic Exenteration for local recurrence of rectal cancer can achieve long-term survival when curative resection is possible and the disease-free interval is long.
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outcome of total Pelvic Exenteration for primary rectal cancer
Diseases of The Colon & Rectum, 2003Co-Authors: Hiroshi Shimada, Shigeki Yamaguchi, Yasushi Ichikawa, Shouichi Fujii, Shigeo OhkiAbstract:PURPOSE: This retrospective study identifies the clinicopathologic factors (age, gender, size of tumor, location, tumor stage, lymph node metastasis, histologic differentiation, and adjuvant therapies) that are useful in predicting long-term survival in patients undergoing total Pelvic Exenteration for advanced primary rectal cancer. METHODS: We reviewed the medical records of 71 patients with stage T3 or T4 primary rectal cancer who underwent a curative total Pelvic Exenteration. The effects of various clinical variables on long-term survival were analyzed. RESULTS: The postoperative mortality, hospital death, and morbidity rates were 1.4, 4.2, and 66.2 percent, respectively. The overall five-year survival rate after total Pelvic Exenteration was 54.1 percent. The five-year survival rate was 65.7 percent for patients with T3 lesions and 39 percent for patients with T4 lesions. A univariate analysis showed that postoperative survival was affected by age, tumor stage, and lymph node metastasis, while a multivariate analysis showed that age and lymph node metastasis were independent prognostic factors. CONCLUSION: Total Pelvic Exenteration may enable long-term survival in younger patients with stage T3 or T4 primary rectal cancer and little or no lymph node metastasis.
Michel Soulié - One of the best experts on this subject based on the ideXlab platform.
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laparoscopy assisted vaginal Pelvic Exenteration
Gynecologic Oncology, 2006Co-Authors: Gwenael Ferron, Benoit Letourneur, Pierre Martel, Denis Querleu, Michel SouliéAbstract:Abstract Objective. The aim of this study was to evaluate the feasibility, morbidity and survival outcome of laparoscopy-assisted vaginal Pelvic Exenteration. Methods. Since 2000, we have performed 5 cases of en-bloc Pelvic Exenteration combining a vaginal or perineal approach and laparoscopic approach. All patients had received previous Pelvic irradiation. One patient underwent a total type II Exenteration with ileal-loop diversion, an omental flap and a temporary colostomy. Two patients underwent a middle and posterior Exenteration: one was a type III Exenteration with perineal rectal resection and a gracilis myocutaneous flap; the second one was a type II Exenteration with a colorectal anastomosis and a vaginal reconstruction using a gluteal thigh flap. Two patients underwent a type I anterior and middle Exenteration with continent Miami pouch and vaginal reconstruction by omental cylinder. Results. Mean time of the procedure was 6 h (range: 4.5–9). Peroperative bleeding was less than 500 cm 3 . Two patients presented minor complications: a perineal abscess after perineal rectal resection and an abdominal wound abscess. Mean length of hospital stay was 27 days. Three patients are free of disease. Two patients presented groin metastasis. One patient died of disease after 8 months. Conclusion. Laparoscopic or laparoscopy-assisted vaginal Pelvic Exenteration followed by reconstruction is feasible with curative intent in selected patients.
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Laparoscopy-assisted vaginal Pelvic Exenteration
Gynecologic Oncology, 2006Co-Authors: Gwenael Ferron, Benoit Letourneur, Pierre Martel, Denis Querleu, Michel SouliéAbstract:Objective. The aim of this study was to evaluate the feasibility, morbidity and survival outcome of laparoscopy-assisted vaginal Pelvic Exenteration. Methods. Since 2000, we have performed 5 cases of en-bloc Pelvic Exenteration combining a vaginal or perineal approach and laparoscopic approach. All patients had received previous Pelvic irradiation. One patient underwent a total type II Exenteration with ileal-loop diversion, an omental flap and a temporary colostomy. Two patients underwent a middle and posterior Exenteration: one was a type III Exenteration with perineal rectal resection and a gracilis myocutaneous flap; the second one was a type II Exenteration with a colorectal anastomosis and a vaginal reconstruction using a gluteal thigh flap. Two patients underwent a type I anterior and middle Exenteration with continent Miami pouch and vaginal reconstruction by omental cylinder. Results. Mean time of the procedure was 6 h (range: 4.5-9). Peroperative bleeding was less than 500 cm3. Two patients presented minor complications: a perineal abscess after perineal rectal resection and an abdominal wound abscess. Mean length of hospital stay was 27 days. Three patients are free of disease. Two patients presented groin metastasis. One patient died of disease after 8 months. Conclusion. Laparoscopic or laparoscopy-assisted vaginal Pelvic Exenteration followed by reconstruction is feasible with curative intent in selected patients. © 2005 Elsevier Inc. All rights reserved.