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1. Palliative pelvic exenteration: A systematic review of patient-centered outcomes

Author

Hidde M. Kroon, N.N. Dudi-Venkata, S. Bedrikovetski, M.L. Thomas, M.E. Kelly, A.G.J. Aalbers, N. Abdul Aziz, M. Abraham-Nordling, T. Akiyoshi, W. Alberda, M. Andric, A. Antoniou, K.K. Austin, R.P. Baker, M. Bali, G. Baseckas, B.K. Bednarski, G.L. Beets, P.L. Berg, J. Beynon, S. Biondo, L. Bordeianou, M. Brunner, P. Buchwald, J.W.A. Burger, D. Burling, N. Campain, K.K.L. Chan, G.J. Chang, M.H. Chew, P. C Chong, H.K. Christensen, M. Codd, A.J. Colquhoun, A. Corr, M. Coscia, P.E. Coyne, B. Creavin, L. Damjanovic, I.R. Daniels, M. Davies, R.J. Davies, J.H.W. de Wilt, Q. Denost, D. Dietz, E.J. Dozois, M. Duff, T. Eglinton, J.M. Enriquez-Navascues, M.D. Evans, N.S. Fearnhead, F.A. Frizelle, E. Garcia-Granero, J.L. Garcia-Sabrido, L. Gentilini, M.L. George, R. Glynn, T. Golda, B. Griffiths, D.A. Harris, M. Evans, J.A.W. Hagemans, D.P. Harji, A.G. Heriot, W. Hohenberger, T. Holm, J.T. Jenkins, S. Kapur, Y. Kanemitsu, S.R. Kelley, D.S. Keller, H. Kim, C.E. Koh, N.F.M. Kok, R. Kokelaar, C. Kontovounisios, M. Kusters, D.W. Larson, W.L. Law, S. Laurberg, P. Lee, M.L. Lydrup, A.C. Lynch, C. Mantyh, K.L. Mathis, A. Martling, W.J.H.J. Meijerink, S. Merkel, A.M. Mehta, F.D. McDermott, J.S. McGrath, A. Mirnezami, J.R. Morton, T.G. Mullaney, J.W. Mesquita-Neto, M.B. Nielsen, G.A.P. Nieuwenhuijzen, P.J. Nilsson, P.R. O'Connell, G. Palmer, D. Patsouras, G. Pellino, G. Poggioli, M. Quinn, A. Quyn, R.W. Radwan, S. Rasheed, P.C. Rasmussen, S.E. Regenbogen, R. Rocha, J. Rothbarth, C. Roxburgh, H.J.T. Rutten, É. Ryan, P.M. Sagar, A. Saklani, A.M.P. Schizas, E. Schwarzkopf, V. Scripcariu, I. Shaikh, D. Shida, A. Simpson, N.J. Smart, J.J. Smith, M.J. Solomon, M.M. Sørensen, S.R. Steele, D. Steffens, L. Stocchi, N.A. Stylianides, P.P. Tekkis, C. Taylor, P. Tsarkov, S. Tsukamoto, W.H. Turner, J.B. Tuynman, G.H. van Ramshorst, D. van Zoggel, W. Vasquez-Jimenez, C. Verhoef, M. Verstegen, C. Wakeman, S. Warrier, H.H. Wasmuth, M.R. Weiser, J.M.D. Wheeler, J. Wild, J. Yip, D.C. Winter, T. Sammour, Kroon H.M., Dudi-Venkata N.N., Bedrikovetski S., Thomas M.L., Kelly M.E., Aalbers A.G.J., Abdul Aziz N., Abraham-Nordling M., Akiyoshi T., Alberda W., Andric M., Antoniou A., Austin K.K., Baker R.P., Bali M., Baseckas G., Bednarski B.K., Beets G.L., Berg P.L., Beynon J., Biondo S., Bordeianou L., Brunner M., Buchwald P., Burger J.W.A., Burling D., Campain N., Chan K.K.L., Chang G.J., Chew M.H., C Chong P., Christensen H.K., Codd M., Colquhoun A.J., Corr A., Coscia M., Coyne P.E., Creavin B., Damjanovic L., Daniels I.R., Davies M., Davies R.J., de Wilt J.H.W., Denost Q., Dietz D., Dozois E.J., Duff M., Eglinton T., Enriquez-Navascues J.M., Evans M.D., Fearnhead N.S., Frizelle F.A., Garcia-Granero E., Garcia-Sabrido J.L., Gentilini L., George M.L., Glynn R., Golda T., Griffiths B., Harris D.A., Evans M., Hagemans J.A.W., Harji D.P., Heriot A.G., Hohenberger W., Holm T., Jenkins J.T., Kapur S., Kanemitsu Y., Kelley S.R., Keller D.S., Kim H., Koh C.E., Kok N.F.M., Kokelaar R., Kontovounisios C., Kusters M., Larson D.W., Law W.L., Laurberg S., Lee P., Lydrup M.L., Lynch A.C., Mantyh C., Mathis K.L., Martling A., Meijerink W.J.H.J., Merkel S., Mehta A.M., McDermott F.D., McGrath J.S., Mirnezami A., Morton J.R., Mullaney T.G., Mesquita-Neto J.W., Nielsen M.B., Nieuwenhuijzen G.A.P., Nilsson P.J., O'Connell P.R., Palmer G., Patsouras D., Pellino G., Poggioli G., Quinn M., Quyn A., Radwan R.W., Rasheed S., Rasmussen P.C., Regenbogen S.E., Rocha R., Rothbarth J., Roxburgh C., Rutten H.J.T., Ryan E., Sagar P.M., Saklani A., Schizas A.M.P., Schwarzkopf E., Scripcariu V., Shaikh I., Shida D., Simpson A., Smart N.J., Smith J.J., Solomon M.J., Sorensen M.M., Steele S.R., Steffens D., Stocchi L., Stylianides N.A., Tekkis P.P., Taylor C., Tsarkov P., Tsukamoto S., Turner W.H., Tuynman J.B., van Ramshorst G.H., van Zoggel D., Vasquez-Jimenez W., Verhoef C., Verstegen M., Wakeman C., Warrier S., Wasmuth H.H., Weiser M.R., Wheeler J.M.D., Wild J., Yip J., Winter D.C., Sammour T., Kroon, Hm, Dudi-Venkata, Nn, Bedrikovetski, S, Thomas, Ml, Kelly, Me, Aalbers, Agj, Abdul Aziz, N, Abraham-Nordling, M, Akiyoshi, T, Alberda, W, Andric, M, Antoniou, A, Austin, Kk, Baker, Rp, Bali, M, Baseckas, G, Bednarski, Bk, Beets, Gl, Berg, Pl, Beynon, J, Biondo, S, Bordeianou, L, Brunner, M, Buchwald, P, Burger, Jwa, Burling, D, Campain, N, Chan, Kkl, Chang, Gj, Chew, Mh, C Chong, P, Christensen, Hk, Codd, M, Colquhoun, Aj, Corr, A, Coscia, M, Coyne, Pe, Creavin, B, Damjanovic, L, Daniels, Ir, Davies, M, Davies, Rj, de Wilt, Jhw, Denost, Q, Dietz, D, Dozois, Ej, Duff, M, Eglinton, T, Enriquez-Navascues, Jm, Evans, Md, Fearnhead, N, Frizelle, Fa, Garcia-Granero, E, Garcia- Sabrido, Jl, Gentilini, L, George, Ml, Glynn, R, Golda, T, Griffiths, B, Harris, Da, Evans, M, Hagemans, Jaw, Harji, Dp, Heriot, Ag, Hohenberger, W, Holm, T, Jenkins, Jt, Kapur, S, Kanemitsu, Y, Kelley, Sr, Keller, D, Kim, H, Koh, Ce, Kok, Nfm, Kokelaar, R, Kontovounisios, C, Kusters, M, Larson, Dw, Law, Wl, Laurberg, S, Lee, P, Lydrup, Ml, Lynch, Ac, Mantyh, C, Mathis, Kl, Martling, A, Meijerink, Wjhj, Merkel, S, Mehta, Am, Mcdermott, Fd, Mcgrath, J, Mirnezami, A, Morton, Jr, Mullaney, Tg, Mesquita-Neto, Jw, Nielsen, Mb, Nieuwenhuijzen, Gap, Nilsson, Pj, O’Connell, Pr, Palmer, G, Patsouras, D, Pellino, G, Poggioli, G, Quinn, M, Quyn, A, Radwan, Rw, Rasheed, S, Rasmussen, Pc, Regenbogen, Se, Rocha, R, Rothbarth, J, Roxburgh, C, Rutten, Hjt, Ryan, E, Sagar, Pm, Saklani, A, Schizas, Amp, Schwarzkopf, E, Scripcariu, V, Shaikh, I, Shida, D, Simpson, A, Smart, Nj, Smith, Jj, Solomon, Mj, Sørensen, Mm, Steele, Sr, Steffens, D, Stocchi, L, Stylianides, Na, Tekkis, Pp, Taylor, C, Tsarkov, P, Tsukamoto, S, Turner, Wh, Tuynman, Jb, van Ramshorst, Gh, van Zoggel, D, Vasquez- Jimenez, W, Verhoef, C, Verstegen, M, Wakeman, C, Warrier, S, Wasmuth, Hh, Weiser, Mr, Wheeler, Jmd, Wild, J, Yip, J, Winter, Dc, and Sammour, T.

Subjects
medicine.medical_specialty, Pelvic Neoplasm, Palliative care, Fistula, medicine.medical_treatment, Disease, Locally advanced pelvic cancer, Tumours of the digestive tract Radboud Institute for Health Sciences [Radboudumc 14], 03 medical and health sciences, 0302 clinical medicine, SDG 3 - Good Health and Well-being, Quality of life, Internal medicine, Patient-Centered Care, Outcome Assessment, Health Care, medicine, Palliative surgery, Humans, Pelvic Neoplasms, Pelvic exenteration, business.industry, Mortality rate, Patient-centered outcomes, Palliative Care, General Medicine, medicine.disease, Pelvic Exenteration, Oncology, 030220 oncology & carcinogenesis, 030211 gastroenterology & hepatology, Surgery, business, Human
Abstract

Item does not contain fulltext OBJECTIVE: Palliative pelvic exenteration (PPE) is a technically complex operation with high morbidity and mortality rates, considered in patients with limited life expectancy. There is little evidence to guide practice. We performed a systematic review to evaluate the impact of PPE on symptom relief and quality of life (QoL). METHODS: A systematic review was conducted according to the PRISMA guidelines using Ovid MEDLINE, EMBASe, and PubMed databases for studies reporting on outcomes of PPE for symptom relief or QoL. Descriptive statistics were used on pooled patient cohorts. RESULTS: Twenty-three historical cohorts and case series were included, comprising 509 patients. No comparative studies were found. Most malignancies were of colorectal, gynaecological and urological origin. Common indications for PPE were pain, symptomatic fistula, bleeding, malodour, obstruction and pelvic sepsis. The pooled median postoperative morbidity rate was 53.6% (13-100%), the median in-hospital mortality was 6.3% (0-66.7%), and median OS was 14 months (4-40 months). Some symptom relief was reported in a median of 79% (50-100%) of the patients, although the magnitude of effect was poorly measured. Data for QoL measures were inconclusive. Five studies discouraged performing PPE in any patient, while 18 studies concluded that the procedure can be considered in highly selected patients. CONCLUSION: Available evidence on PPE is of low-quality. Morbidity and mortality rates are high with a short median OS interval. While some symptom relief may be afforded by this procedure, evidence for improvement in QoL is limited. A highly selective individualised approach is required to optimise the risk:benefit equation.

Published
2019
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2. The impact of the COVID-19 pandemic on the Management of Locally Advanced Primary/Recurrent Rectal Cancer

Author

Chok A. Y., Kontovounisios C., Rasheed S., Kelly M. E., Agj A., Abdul Aziz N., Abecasis N., Abraham-Nordling M., Akiyoshi T., Alberda W., Albert M., Andric M., Angenete E., Antoniou A., Auer R., Austin K. K., Aziz O., Baker R. P., Bali M., Baseckas G., Bebington B., Bedford M., Bednarski B. K., Beets G. L., Berg P. L., Beynon J., Biondo S., Boyle K., Bordeianou L., Bremers A. B., Brunner M., Buchwald P., Bui A., Burgess A., Jwa B., Burling D., Burns E., Campain N., Carvalhal S., Castro L., Caycedo-Marulanda A., Kkl C., Chang G. J., Chang M., Chew M. H., Chong P., Christensen H. K., Clouston H., Codd M., Collins D., Colquhoun A. J., Corr A., Coscia M., Cosimelli M., Coyne P. E., Creavin B., Croner R. S., Damjanovic L., Daniels I. R., Davies M., Davies R. J., Delaney C. P., Jhw D. W., Denost Q., Deutsch C., Dietz D., Domingo S., Dozois E. J., Duff M., Eglinton T., Enrique-Navascues J. M., Espin-Basany E., Evans M. D., Fearnhead N. S., Flatmark K., Fleming F., Frizelle F. A., Gallego M. A., Garcia-Granero E., Garcia-Sabrido J. L., Gentilini L., George M. L., George V., Ghouti L., Giner F., Ginther N., Glynn R., Golda T., Griffiths B., Harris D. A., Jaw H., Hanchanale V., Harji D. P., Helewa R. M., Hellawell G., Heriot A. G., Hochman D., Hohenberger W., Holm T., Hompes R., Jenkins J. T., Kaffenberger S., Kandaswamy G. V., Kapur S., Kanemitsu Y., Kelley S. R., Keller D. S., Khan M. S., Kim H., Kim H. J., Koh C. E., Nfm K., Kokelaar R., Kristensen H. O., Kroon H. M., Kusters M., Lago V., Larsen S. G., Larson D. W., Law W. L., Laurberg S., Lee P. J., Limbert M., Lydrup M. L., Lyons A., Lynch A. C., Mantyh C., Mathis K. L., Cfs M., Martling A., Wjhj M., Merkel S., Mehta A. M., McArthur D. R., McDermott F. D., McGrath J. S., Malde S., Mirnezami A., Jrt M., Morton J. R., Mullaney T. G., Negoi I., Jwm N., Ng J. L., Nguyen B., Nielsen M. B., Gap N., Nilsson P. J., Oliver A., O'Dwyer S. T., Palmer G., Pappou E., Park J., Patsouras D., Pellino G., Peterson A. C., Poggioli G., Proud D., Quinn M., Quyn A., Radwan R. W., Rasmussen P. C., Rausa E., Regenbogen S. E., Renehan A., Rocha R., Rochester M., Rohila J., Rothbarth J., Rottoli M., Roxburgh C., Hjt R., Ryan E. J., Safar B., Sagar P. M., Sahai A., Saklani A., Sammour T., Sayyed R., Amp S., Schwarzkopf E., Scripcariu V., Selvasekar C., Shaikh I., Shida D., Simpson A., Smart N. J., Smart P., Smith J. J., Solbakken A. M., Solomon M. J., Sorensen M. M., Steele S. R., Steffens D., Stitzenberg K., Stocchi L., Stylianides N. A., Swartling T., Sumrien H., Sutton P. A., Swartking T., Tan E. J., Taylor C., Teras J., Thurairaja R., Toh E. L., Tsarkov P., Tsukada Y., Tsukamoto S., Tuech J. J., Turner W. H., Tuynman J. B., van Ramshorst G. H., van Zoggel D., Vasquez-Jimenez W., Verhoef C., Vizzielli G., Elk V., Uehara K., Wakeman C., Warrier S., Wasmuth H. H., Weber K., Weiser M. R., Jmd W., Wild J., Wilson M., Wolthuis A., Yano H., Yip B., Yip J., Yoo R. N., Zappa M. A., Winter D. C., Tekkis P. P., Chok A.Y., Kontovounisios C., Rasheed S., Kelly M.E., Agj A., Abdul Aziz N., Abecasis N., Abraham-Nordling M., Akiyoshi T., Alberda W., Albert M., Andric M., Angenete E., Antoniou A., Auer R., Austin K.K., Aziz O., Baker R.P., Bali M., Baseckas G., Bebington B., Bedford M., Bednarski B.K., Beets G.L., Berg P.L., Beynon J., Biondo S., Boyle K., Bordeianou L., Bremers A.B., Brunner M., Buchwald P., Bui A., Burgess A., Jwa B., Burling D., Burns E., Campain N., Carvalhal S., Castro L., Caycedo-Marulanda A., Kkl C., Chang G.J., Chang M., Chew M.H., Chong P., Christensen H.K., Clouston H., Codd M., Collins D., Colquhoun A.J., Corr A., Coscia M., Cosimelli M., Coyne P.E., Creavin B., Croner R.S., Damjanovic L., Daniels I.R., Davies M., Davies R.J., Delaney C.P., Jhw D.W., Denost Q., Deutsch C., Dietz D., Domingo S., Dozois E.J., Duff M., Eglinton T., Enrique-Navascues J.M., Espin-Basany E., Evans M.D., Fearnhead N.S., Flatmark K., Fleming F., Frizelle F.A., Gallego M.A., Garcia-Granero E., Garcia-Sabrido J.L., Gentilini L., George M.L., George V., Ghouti L., Giner F., Ginther N., Glynn R., Golda T., Griffiths B., Harris D.A., Jaw H., Hanchanale V., Harji D.P., Helewa R.M., Hellawell G., Heriot A.G., Hochman D., Hohenberger W., Holm T., Hompes R., Jenkins J.T., Kaffenberger S., Kandaswamy G.V., Kapur S., Kanemitsu Y., Kelley S.R., Keller D.S., Khan M.S., Kim H., Kim H.J., Koh C.E., Nfm K., Kokelaar R., Kristensen H.O., Kroon H.M., Kusters M., Lago V., Larsen S.G., Larson D.W., Law W.L., Laurberg S., Lee P.J., Limbert M., Lydrup M.L., Lyons A., Lynch A.C., Mantyh C., Mathis K.L., Cfs M., Martling A., Wjhj M., Merkel S., Mehta A.M., McArthur D.R., McDermott F.D., McGrath J.S., Malde S., Mirnezami A., Jrt M., Morton J.R., Mullaney T.G., Negoi I., Jwm N., Ng J.L., Nguyen B., Nielsen M.B., Gap N., Nilsson P.J., Oliver A., O'Dwyer S.T., Palmer G., Pappou E., Park J., Patsouras D., Pellino G., Peterson A.C., Poggioli G., Proud D., Quinn M., Quyn A., Radwan R.W., Rasmussen P.C., Rausa E., Regenbogen S.E., Renehan A., Rocha R., Rochester M., Rohila J., Rothbarth J., Rottoli M., Roxburgh C., Hjt R., Ryan E.J., Safar B., Sagar P.M., Sahai A., Saklani A., Sammour T., Sayyed R., Amp S., Schwarzkopf E., Scripcariu V., Selvasekar C., Shaikh I., Shida D., Simpson A., Smart N.J., Smart P., Smith J.J., Solbakken A.M., Solomon M.J., Sorensen M.M., Steele S.R., Steffens D., Stitzenberg K., Stocchi L., Stylianides N.A., Swartling T., Sumrien H., Sutton P.A., Swartking T., Tan E.J., Taylor C., Teras J., Thurairaja R., Toh E.L., Tsarkov P., Tsukada Y., Tsukamoto S., Tuech J.J., Turner W.H., Tuynman J.B., van Ramshorst G.H., van Zoggel D., Vasquez-Jimenez W., Verhoef C., Vizzielli G., Elk V., Uehara K., Wakeman C., Warrier S., Wasmuth H.H., Weber K., Weiser M.R., Jmd W., Wild J., Wilson M., Wolthuis A., Yano H., Yip B., Yip J., Yoo R.N., Zappa M.A., Winter D.C., Tekkis P.P., Chok, A. Y., Kontovounisios, C., Rasheed, S., Kelly, M. E., Agj, A., Abdul Aziz, N., Abecasis, N., Abraham-Nordling, M., Akiyoshi, T., Alberda, W., Albert, M., Andric, M., Angenete, E., Antoniou, A., Auer, R., Austin, K. K., Aziz, O., Baker, R. P., Bali, M., Baseckas, G., Bebington, B., Bedford, M., Bednarski, B. K., Beets, G. L., Berg, P. L., Beynon, J., Biondo, S., Boyle, K., Bordeianou, L., Bremers, A. B., Brunner, M., Buchwald, P., Bui, A., Burgess, A., Jwa, B., Burling, D., Burns, E., Campain, N., Carvalhal, S., Castro, L., Caycedo-Marulanda, A., Kkl, C., Chang, G. J., Chang, M., Chew, M. H., Chong, P., Christensen, H. K., Clouston, H., Codd, M., Collins, D., Colquhoun, A. J., Corr, A., Coscia, M., Cosimelli, M., Coyne, P. E., Creavin, B., Croner, R. S., Damjanovic, L., Daniels, I. R., Davies, M., Davies, R. J., Delaney, C. P., Jhw, D. W., Denost, Q., Deutsch, C., Dietz, D., Domingo, S., Dozois, E. J., Duff, M., Eglinton, T., Enrique-Navascues, J. M., Espin-Basany, E., Evans, M. D., Fearnhead, N. S., Flatmark, K., Fleming, F., Frizelle, F. A., Gallego, M. A., Garcia-Granero, E., Garcia-Sabrido, J. L., Gentilini, L., George, M. L., George, V., Ghouti, L., Giner, F., Ginther, N., Glynn, R., Golda, T., Griffiths, B., Harris, D. A., Jaw, H., Hanchanale, V., Harji, D. P., Helewa, R. M., Hellawell, G., Heriot, A. G., Hochman, D., Hohenberger, W., Holm, T., Hompes, R., Jenkins, J. T., Kaffenberger, S., Kandaswamy, G. V., Kapur, S., Kanemitsu, Y., Kelley, S. R., Keller, D. S., Khan, M. S., Kim, H., Kim, H. J., Koh, C. E., Nfm, K., Kokelaar, R., Kristensen, H. O., Kroon, H. M., Kusters, M., Lago, V., Larsen, S. G., Larson, D. W., Law, W. L., Laurberg, S., Lee, P. J., Limbert, M., Lydrup, M. L., Lyons, A., Lynch, A. C., Mantyh, C., Mathis, K. L., Cfs, M., Martling, A., Wjhj, M., Merkel, S., Mehta, A. M., Mcarthur, D. R., Mcdermott, F. D., Mcgrath, J. S., Malde, S., Mirnezami, A., Jrt, M., Morton, J. R., Mullaney, T. G., Negoi, I., Jwm, N., Ng, J. L., Nguyen, B., Nielsen, M. B., Gap, N., Nilsson, P. J., Oliver, A., O'Dwyer, S. T., Palmer, G., Pappou, E., Park, J., Patsouras, D., Pellino, G., Peterson, A. C., Poggioli, G., Proud, D., Quinn, M., Quyn, A., Radwan, R. W., Rasmussen, P. C., Rausa, E., Regenbogen, S. E., Renehan, A., Rocha, R., Rochester, M., Rohila, J., Rothbarth, J., Rottoli, M., Roxburgh, C., Hjt, R., Ryan, E. J., Safar, B., Sagar, P. M., Sahai, A., Saklani, A., Sammour, T., Sayyed, R., Amp, S., Schwarzkopf, E., Scripcariu, V., Selvasekar, C., Shaikh, I., Shida, D., Simpson, A., Smart, N. J., Smart, P., Smith, J. J., Solbakken, A. M., Solomon, M. J., Sorensen, M. M., Steele, S. R., Steffens, D., Stitzenberg, K., Stocchi, L., Stylianides, N. A., Swartling, T., Sumrien, H., Sutton, P. A., Swartking, T., Tan, E. J., Taylor, C., Teras, J., Thurairaja, R., Toh, E. L., Tsarkov, P., Tsukada, Y., Tsukamoto, S., Tuech, J. J., Turner, W. H., Tuynman, J. B., van Ramshorst, G. H., van Zoggel, D., Vasquez-Jimenez, W., Verhoef, C., Vizzielli, G., Elk, V., Uehara, K., Wakeman, C., Warrier, S., Wasmuth, H. H., Weber, K., Weiser, M. R., Jmd, W., Wild, J., Wilson, M., Wolthuis, A., Yano, H., Yip, B., Yip, J., Yoo, R. N., Zappa, M. A., Winter, D. C., Tekkis, P. P., and Surgery

Subjects
Oncology, medicine.medical_specialty, Coronavirus disease 2019 (COVID-19), Locally advanced, MEDLINE, Comorbidity, COVID-19 - advanced - recurrent - primary - rectal cancer, SDG 3 - Good Health and Well-being, Internal medicine, Pandemic, Correspondence, medicine, Combined Modality Therapy, Humans, General, Pandemics, Recurrent Rectal Cancer, Neoplasm Staging, business.industry, Rectal Neoplasms, SARS-CoV-2, COVID-19, medicine.disease, Neoplasm staging, Surgery, Neoplasm Recurrence, Local, business
Published
2020

3. Predicting outcomes of pelvic exenteration using machine learning

Author

Dudurych I., Kelly M. E., Aalbers A. G. J., Abdul Aziz N., Abecasis N., Abraham-Nordling M., Akiyoshi T., Alberda W., Albert M., Andric M., Angenete E., Antoniou A., Auer R., Austin K. K., Aziz O., Baker R. P., Bali M., Baseckas G., Bebington B., Bedford M., Bednarski B. K., Beets G. L., Berg P. L., Beynon J., Biondo S., Boyle K., Bordeianou L., Bremers A. B., Brunner M., Buchwald P., Bui A., Burgess A., Burger J. W. A., Burling D., Burns E., Campain N., Carvalhal S., Castro L., Caycedo-Marulanda A., Chan K. K. L., Chang G. J., Chew M. H., Chok A. K., Chong P., Christensen H. K., Clouston H., Codd M., Collins D., Colquhoun A. J., Corr A., Coscia M., Coyne P. E., Creavin B., Croner R. S., Damjanovic L., Daniels I. R., Davies M., Davies R. J., Delaney C. P., Wilt J. H. W., Denost Q., Deutsch C., Dietz D., Domingo S., Dozois E. J., Duff M., Eglinton T., Enrique-Navascues J. M., Espin-Basany E., Evans M. D., Fearnhead N. S., Flatmark K., Fleming F., Frizelle F. A., Gallego M. A., Garcia-Granero E., Garcia-Sabrido J. L., Gentilini L., George M. L., George V., Ghouti L., Giner F., Ginther N., Glynn R., Golda T., Griffiths B., Harris D. A., Hagemans J. A. W., Hanchanale V., Harji D. P., Helewa R. M., Heriot A. G., Hochman D., Hohenberger W., Holm T., Hompes R., Jenkins J. T., Kaffenberger S., Kandaswamy G. V., Kapur S., Kanemitsu Y., Kelley S. R., Keller D. S., Khan M. S., Kiran R. P., Kim H., Kim H. J., Koh C. E., Kok N. F. M., Kokelaar R., Kontovounisios C., Kristensen H. O., Kroon H. M., Kusters M., Lago V., Larsen S. G., Larson D. W., Law W. L., Laurberg S., Lee P. J., Limbert M., Lydrup M. L., Lyons A., Lynch A. C., Mantyh C., Mathis K. L., Margues C. F. S., Martling A., Meijerink W. J. H. J., Merkel S., Mehta A. M., McArthur D. R., McDermott F. D., McGrath J. S., Malde S., Mirnezami A., Monson J. R. T., Morton J. R., Mullaney T. G., Negoi I., Neto J. W. M., Nguyen B., Nielsen M. B., Nieuwenhuijzen G. A. P., Nilsson P. J., Oliver A., O'Connell P. R., O'Dwyer S. T., Palmer G., Pappou E., Park J., Patsouras D., Pellino G., Peterson A. C., Poggioli G., Proud D., Quinn M., Quyn A., Radwan R. W., Rasheed S., Rasmussen P. C., Regenbogen S. E., Renehan A., Rocha R., Rochester M., Rohila J., Rothbarth J., Rottoli M., Roxburgh C., Rutten H. J. T., Ryan E. J., Safar B., Sagar P. M., Sahai A., Saklani A., Sammour T., Sayyed R., Schizas A. M. P., Schwarzkopf E., Scripcariu V., Selvasekar C., Shaikh I., Shellawell G., Shida D., Simpson A., Smart N. J., Smart P., Smith J. J., Solbakken A. M., Solomon M. J., Sorensen M. M., Steele S. R., Steffens D., Stitzenberg K., Stocchi L., Stylianides N. A., Swartling T., Sumrien H., Sutton P. A., Swartking T., Tan E. J., Taylor C., Tekkis P. P., Teras J., Thurairaja R., Toh E. L., Tsarkov P., Tsukada Y., Tsukamoto S., Tuech J. J., Turner W. H., Tuynman J. B., van Ramshorst G. H., van Zoggel D., Vasquez-Jimenez W., Verhoef C., Vizzielli G., Voogt E. L. K., Uehara K., Wakeman C., Warrier S., Wasmuth H. H., Weber K., Weiser M. R., Wheeler J. M. D., Wild J., Wilson M., Wolthuis A., Yano H., Yip B., Yip J., Yoo R. N., Winter D. C., Dudurych I., Kelly M.E., Aalbers A.G.J., Abdul Aziz N., Abecasis N., Abraham-Nordling M., Akiyoshi T., Alberda W., Albert M., Andric M., Angenete E., Antoniou A., Auer R., Austin K.K., Aziz O., Baker R.P., Bali M., Baseckas G., Bebington B., Bedford M., Bednarski B.K., Beets G.L., Berg P.L., Beynon J., Biondo S., Boyle K., Bordeianou L., Bremers A.B., Brunner M., Buchwald P., Bui A., Burgess A., Burger J.W.A., Burling D., Burns E., Campain N., Carvalhal S., Castro L., Caycedo-Marulanda A., Chan K.K.L., Chang G.J., Chew M.H., Chok A.K., Chong P., Christensen H.K., Clouston H., Codd M., Collins D., Colquhoun A.J., Corr A., Coscia M., Coyne P.E., Creavin B., Croner R.S., Damjanovic L., Daniels I.R., Davies M., Davies R.J., Delaney C.P., Wilt J.H.W., Denost Q., Deutsch C., Dietz D., Domingo S., Dozois E.J., Duff M., Eglinton T., Enrique-Navascues J.M., Espin-Basany E., Evans M.D., Fearnhead N.S., Flatmark K., Fleming F., Frizelle F.A., Gallego M.A., Garcia-Granero E., Garcia-Sabrido J.L., Gentilini L., George M.L., George V., Ghouti L., Giner F., Ginther N., Glynn R., Golda T., Griffiths B., Harris D.A., Hagemans J.A.W., Hanchanale V., Harji D.P., Helewa R.M., Heriot A.G., Hochman D., Hohenberger W., Holm T., Hompes R., Jenkins J.T., Kaffenberger S., Kandaswamy G.V., Kapur S., Kanemitsu Y., Kelley S.R., Keller D.S., Khan M.S., Kiran R.P., Kim H., Kim H.J., Koh C.E., Kok N.F.M., Kokelaar R., Kontovounisios C., Kristensen H.O., Kroon H.M., Kusters M., Lago V., Larsen S.G., Larson D.W., Law W.L., Laurberg S., Lee P.J., Limbert M., Lydrup M.L., Lyons A., Lynch A.C., Mantyh C., Mathis K.L., Margues C.F.S., Martling A., Meijerink W.J.H.J., Merkel S., Mehta A.M., McArthur D.R., McDermott F.D., McGrath J.S., Malde S., Mirnezami A., Monson J.R.T., Morton J.R., Mullaney T.G., Negoi I., Neto J.W.M., Nguyen B., Nielsen M.B., Nieuwenhuijzen G.A.P., Nilsson P.J., Oliver A., O'Connell P.R., O'Dwyer S.T., Palmer G., Pappou E., Park J., Patsouras D., Pellino G., Peterson A.C., Poggioli G., Proud D., Quinn M., Quyn A., Radwan R.W., Rasheed S., Rasmussen P.C., Regenbogen S.E., Renehan A., Rocha R., Rochester M., Rohila J., Rothbarth J., Rottoli M., Roxburgh C., Rutten H.J.T., Ryan E.J., Safar B., Sagar P.M., Sahai A., Saklani A., Sammour T., Sayyed R., Schizas A.M.P., Schwarzkopf E., Scripcariu V., Selvasekar C., Shaikh I., Shellawell G., Shida D., Simpson A., Smart N.J., Smart P., Smith J.J., Solbakken A.M., Solomon M.J., Sorensen M.M., Steele S.R., Steffens D., Stitzenberg K., Stocchi L., Stylianides N.A., Swartling T., Sumrien H., Sutton P.A., Swartking T., Tan E.J., Taylor C., Tekkis P.P., Teras J., Thurairaja R., Toh E.L., Tsarkov P., Tsukada Y., Tsukamoto S., Tuech J.J., Turner W.H., Tuynman J.B., van Ramshorst G.H., van Zoggel D., Vasquez-Jimenez W., Verhoef C., Vizzielli G., Voogt E.L.K., Uehara K., Wakeman C., Warrier S., Wasmuth H.H., Weber K., Weiser M.R., Wheeler J.M.D., Wild J., Wilson M., Wolthuis A., Yano H., Yip B., Yip J., Yoo R.N., Winter D.C., Surgery, Dudurych, I., Kelly, M. E., Aalbers, A. G. J., Abdul Aziz, N., Abecasis, N., Abraham-Nordling, M., Akiyoshi, T., Alberda, W., Albert, M., Andric, M., Angenete, E., Antoniou, A., Auer, R., Austin, K. K., Aziz, O., Baker, R. P., Bali, M., Baseckas, G., Bebington, B., Bedford, M., Bednarski, B. K., Beets, G. L., Berg, P. L., Beynon, J., Biondo, S., Boyle, K., Bordeianou, L., Bremers, A. B., Brunner, M., Buchwald, P., Bui, A., Burgess, A., Burger, J. W. A., Burling, D., Burns, E., Campain, N., Carvalhal, S., Castro, L., Caycedo-Marulanda, A., Chan, K. K. L., Chang, G. J., Chew, M. H., Chok, A. K., Chong, P., Christensen, H. K., Clouston, H., Codd, M., Collins, D., Colquhoun, A. J., Corr, A., Coscia, M., Coyne, P. E., Creavin, B., Croner, R. S., Damjanovic, L., Daniels, I. R., Davies, M., Davies, R. J., Delaney, C. P., Wilt, J. H. W., Denost, Q., Deutsch, C., Dietz, D., Domingo, S., Dozois, E. J., Duff, M., Eglinton, T., Enrique-Navascues, J. M., Espin-Basany, E., Evans, M. D., Fearnhead, N. S., Flatmark, K., Fleming, F., Frizelle, F. A., Gallego, M. A., Garcia-Granero, E., Garcia-Sabrido, J. L., Gentilini, L., George, M. L., George, V., Ghouti, L., Giner, F., Ginther, N., Glynn, R., Golda, T., Griffiths, B., Harris, D. A., Hagemans, J. A. W., Hanchanale, V., Harji, D. P., Helewa, R. M., Heriot, A. G., Hochman, D., Hohenberger, W., Holm, T., Hompes, R., Jenkins, J. T., Kaffenberger, S., Kandaswamy, G. V., Kapur, S., Kanemitsu, Y., Kelley, S. R., Keller, D. S., Khan, M. S., Kiran, R. P., Kim, H., Kim, H. J., Koh, C. E., Kok, N. F. M., Kokelaar, R., Kontovounisios, C., Kristensen, H. O., Kroon, H. M., Kusters, M., Lago, V., Larsen, S. G., Larson, D. W., Law, W. L., Laurberg, S., Lee, P. J., Limbert, M., Lydrup, M. L., Lyons, A., Lynch, A. C., Mantyh, C., Mathis, K. L., Margues, C. F. S., Martling, A., Meijerink, W. J. H. J., Merkel, S., Mehta, A. M., Mcarthur, D. R., Mcdermott, F. D., Mcgrath, J. S., Malde, S., Mirnezami, A., Monson, J. R. T., Morton, J. R., Mullaney, T. G., Negoi, I., Neto, J. W. M., Nguyen, B., Nielsen, M. B., Nieuwenhuijzen, G. A. P., Nilsson, P. J., Oliver, A., O'Connell, P. R., O'Dwyer, S. T., Palmer, G., Pappou, E., Park, J., Patsouras, D., Pellino, G., Peterson, A. C., Poggioli, G., Proud, D., Quinn, M., Quyn, A., Radwan, R. W., Rasheed, S., Rasmussen, P. C., Regenbogen, S. E., Renehan, A., Rocha, R., Rochester, M., Rohila, J., Rothbarth, J., Rottoli, M., Roxburgh, C., Rutten, H. J. T., Ryan, E. J., Safar, B., Sagar, P. M., Sahai, A., Saklani, A., Sammour, T., Sayyed, R., Schizas, A. M. P., Schwarzkopf, E., Scripcariu, V., Selvasekar, C., Shaikh, I., Shellawell, G., Shida, D., Simpson, A., Smart, N. J., Smart, P., Smith, J. J., Solbakken, A. M., Solomon, M. J., Sorensen, M. M., Steele, S. R., Steffens, D., Stitzenberg, K., Stocchi, L., Stylianides, N. A., Swartling, T., Sumrien, H., Sutton, P. A., Swartking, T., Tan, E. J., Taylor, C., Tekkis, P. P., Teras, J., Thurairaja, R., Toh, E. L., Tsarkov, P., Tsukada, Y., Tsukamoto, S., Tuech, J. J., Turner, W. H., Tuynman, J. B., van Ramshorst, G. H., van Zoggel, D., Vasquez-Jimenez, W., Verhoef, C., Vizzielli, G., Voogt, E. L. K., Uehara, K., Wakeman, C., Warrier, S., Wasmuth, H. H., Weber, K., Weiser, M. R., Wheeler, J. M. D., Wild, J., Wilson, M., Wolthuis, A., Yano, H., Yip, B., Yip, J., Yoo, R. N., and Winter, D. C.

Subjects
Artificial intelligence, medicine.medical_treatment, Machine learning, computer.software_genre, Logistic regression, Tumours of the digestive tract Radboud Institute for Health Sciences [Radboudumc 14], SDG 3 - Good Health and Well-being, Medicine, Humans, Pelvic exenteration, Receiver operating characteristic, Artificial neural network, business.industry, Rectal Neoplasms, Deep learning, Gastroenterology, Prognosis, pelvic exenteration, Support vector machine, machine learning, Test set, colorectal surgery, Neoplasm Recurrence, Local, business, computer, Predictive modelling, artificial neural network
Abstract

Aim: We aim to compare machine learning with neural network performance in predicting R0 resection (R0), length of stay >14days (LOS), major complication rates at 30days postoperatively (COMP) and survival greater than 1 year (SURV) for patients having pelvic exenteration for locally advanced and recurrent rectal cancer. Method: A deep learning computer was built and the programming environment was established. The PelvEx Collaborative database was used which contains anonymized data on patients who underwent pelvic exenteration for locally advanced or locally recurrent colorectal cancer between 2004 and 2014. Logistic regression, a support vector machine and an artificial neural network (ANN) were trained. Twenty per cent of the data were used as a test set for calculating prediction accuracy for R0, LOS, COMP and SURV. Model performance was measured by plotting receiver operating characteristic (ROC) curves and calculating the area under the ROC curve (AUROC). Results: Machine learning models and ANNs were trained on 1147 cases. The AUROC for all outcome predictions ranged from 0.608 to 0.793 indicating modest to moderate predictive ability. The models performed best at predicting LOS >14days with an AUROC of 0.793 using preoperative and operative data. Visualized logistic regression model weights indicate a varying impact of variables on the outcome in question. Conclusion: This paper highlights the potential for predictive modelling of large international databases. Current data allow moderate predictive ability of both complex ANNs and more classic methods.

Published
2020

4. Factors affecting outcomes following pelvic exenteration for locally recurrent rectal cancer

Author

Kelly M. E., Glynn R., Aalbers A. G. J., Abraham-Nordling M., Alberda W., Antoniou A., Austin K. K., Beets G. L., Beynon J., Bosman S. J., Brunner M., Buchler M. W., Burger J. W. A., Campain N., Christensen H. K., Codd M., Coscia M., Colquhoun A. J., Daniels I. R., Davies R. J., de Wilt J. H. W., Deutsch C., Dietz D., Eglinton T., Fearnhead N., Frizelle F. A., Garcia-Sabrido J. L., George M. L., Gentilini L., Harris D. A., Harji D., Heriot A. G., Hohenberger Brunner W., Jenkins J. T., Kanemitsu Y., Chan K. K. L., Kim H., Koh C. E., Kok N. F., Kontovounisios C., Kulu Y., Law W. L., Le G. N., Lee P., Lydrup M. L., Lynch A. C., Martling A., Meijerink J., Merkel S., McDermott F. D., McGrath J. S., Nielsen Christensen M. B., Nieuwenhuijzen G. A. P., Nordling M. A., Northover J. M. A., O'Connell P. R., Patsouras D., Poggioli G., Radwan R. W., Rasheed S., Rasmussen P. C., Rothbarth J., Rutten H. J. T., Sagar P. M., Schizas A. M. P., Shida D., Smart N. J., Solomon M. J., Stocchi L., Tekkis P. P., Tsukamoto S., Turner W. H., Tuynman J., Ulrich A., van Leeuwenhoek A., van Ramshorst G. H., Vasquez-Jimenez W., Verhoef C., Versteegen M., Wakeman C., Warrier S., Yip J., Winter D. C., Surgery, Kelly M.E., Glynn R., Aalbers A.G.J., Abraham-Nordling M., Alberda W., Antoniou A., Austin K.K., Beets G.L., Beynon J., Bosman S.J., Brunner M., Buchler M.W., Burger J.W.A., Campain N., Christensen H.K., Codd M., Coscia M., Colquhoun A.J., Daniels I.R., Davies R.J., de Wilt J.H.W., Deutsch C., Dietz D., Eglinton T., Fearnhead N., Frizelle F.A., Garcia-Sabrido J.L., George M.L., Gentilini L., Harris D.A., Harji D., Heriot A.G., Hohenberger Brunner W., Jenkins J.T., Kanemitsu Y., Chan K.K.L., Kim H., Koh C.E., Kok N.F., Kontovounisios C., Kulu Y., Law W.L., Le G.N., Lee P., Lydrup M.L., Lynch A.C., Martling A., Meijerink J., Merkel S., McDermott F.D., McGrath J.S., Nielsen Christensen M.B., Nieuwenhuijzen G.A.P., Nordling M.A., Northover J.M.A., O'Connell P.R., Patsouras D., Poggioli G., Radwan R.W., Rasheed S., Rasmussen P.C., Rothbarth J., Rutten H.J.T., Sagar P.M., Schizas A.M.P., Shida D., Smart N.J., Solomon M.J., Stocchi L., Tekkis P.P., Tsukamoto S., Turner W.H., Tuynman J., Ulrich A., van Leeuwenhoek A., van Ramshorst G.H., Vasquez-Jimenez W., Verhoef C., Versteegen M., Wakeman C., Warrier S., Yip J., Winter D.C., AGEM - Re-generation and cancer of the digestive system, and CCA - Cancer Treatment and quality of life

Subjects
Male, medicine.medical_specialty, medicine.medical_treatment, 030230 surgery, Tumours of the digestive tract Radboud Institute for Health Sciences [Radboudumc 14], 03 medical and health sciences, 0302 clinical medicine, SDG 3 - Good Health and Well-being, medicine, Clinical endpoint, Humans, Survival rate, Survival analysis, Neoadjuvant therapy, Aged, Rectal Neoplasm, Pelvic exenteration, Rectal Neoplasms, business.industry, Odds ratio, Middle Aged, Survival Analysis, Neoadjuvant Therapy, Pelvic Exenteration, Surgery, Radiation therapy, Treatment Outcome, 030220 oncology & carcinogenesis, Resection margin, Female, Survival Analysi, Neoplasm Recurrence, Local, business, Human
Abstract

Background Pelvic exenteration for locally recurrent rectal cancer (LRRC) is associated with variable outcomes, with the majority of data from single-centre series. This study analysed data from an international collaboration to determine robust parameters that could inform clinical decision-making. Methods Anonymized data on patients who had pelvic exenteration for LRRC between 2004 and 2014 were accrued from 27 specialist centres. The primary endpoint was survival. The impact of resection margin, bone resection, node status and use of neoadjuvant therapy (before exenteration) was assessed. Results Of 1184 patients, 614 (51·9 per cent) had neoadjuvant therapy. A clear resection margin (R0 resection) was achieved in 55·4 per cent of operations. Twenty-one patients (1·8 per cent) died within 30 days and 380 (32·1 per cent) experienced a major complication. Median overall survival was 36 months following R0 resection, 27 months after R1 resection and 16 months following R2 resection (P < 0·001). Patients who received neoadjuvant therapy had more postoperative complications (unadjusted odds ratio (OR) 1·53), readmissions (unadjusted OR 2·33) and radiological reinterventions (unadjusted OR 2·12). Three-year survival rates were 48·1 per cent, 33·9 per cent and 15 per cent respectively. Bone resection (when required) was associated with a longer median survival (36 versus 29 months; P < 0·001). Node-positive patients had a shorter median overall survival than those with node-negative disease (22 versus 29 months respectively). Multivariable analysis identified margin status and bone resection as significant determinants of long-term survival. Conclusion Negative margins and bone resection (where needed) were identified as the most important factors influencing overall survival. Neoadjuvant therapy before pelvic exenteration did not affect survival, but was associated with higher rates of readmission, complications and radiological reintervention.

Published
2018
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5. Minimally invasive surgery techniques in pelvic exenteration: a systematic and meta-analysis review

Author

Srinivasaiah N., Shekleton F., Kelly M. E., Harji D., Malietzis G., Askari A., Aalbers A. G. J., Alberda W., Antoniou A., Austin K. K., Beets G. L., Berg P. L., Beynon J., Bosman S. J., Brunner M., Burger J. W. A., Campain N., Christensen H. K., Coscia M., Colquhoun A. J., Coyne P., Daniels I. R., Davies R. J., de Wilt J. H. W., Denost Q., Deutsch C., Dietz D., Duff M., Eglinton T., Fearnhead N., Frizelle F. A., Garcia-Sabrido J. L., George M. L., Gentilini L., Griffiths B., Harris D. A., Evans M., Heriot A. G., Hohenberger W., Hoe C. M., Holm T., Kanemitsu Y., Chan K. K. L., Kim H., Koh C. E., Kok N. F., Kontovounisios C., Law W. L., Laurberg S., Lee P., Lydrup M. L., Lynch A. C., Martling A., Meijerink J., Mentha A., Merkel S., McDermott F. D., McGrath J. S., Nielsen M. B., Nieuwenhuijzen G. A. P., Nilsson P. J., Abraham-Nordling M., O'Connell P. R., Patsouras D., Poggioli G., Radwan R. W., Rasheed S., Rasmussen P. C., Rothbarth J., Rutten H. J. T., Sagar P. M., Schizas A. M. P., Shida D., Smart N. J., Solomon M. J., Sorensen M. M., Stocchi L., Tekkis P. P., Tsukamoto S., Turner W. H., Tuynman J. B., van Ramshorst G. H., van Zoggel D., Vasquez-Jimenez W., Verhoef C., Verstegen M., Wakeman C., Warrier S., Yip J., Winter D. C., Jenkins J. T., Srinivasaiah N., Shekleton F., Kelly M.E., Harji D., Malietzis G., Askari A., Aalbers A.G.J., Alberda W., Antoniou A., Austin K.K., Beets G.L., Berg P.L., Beynon J., Bosman S.J., Brunner M., Burger J.W.A., Campain N., Christensen H.K., Coscia M., Colquhoun A.J., Coyne P., Daniels I.R., Davies R.J., de Wilt J.H.W., Denost Q., Deutsch C., Dietz D., Duff M., Eglinton T., Fearnhead N., Frizelle F.A., Garcia-Sabrido J.L., George M.L., Gentilini L., Griffiths B., Harris D.A., Evans M., Heriot A.G., Hohenberger W., Hoe C.M., Holm T., Kanemitsu Y., Chan K.K.L., Kim H., Koh C.E., Kok N.F., Kontovounisios C., Law W.L., Laurberg S., Lee P., Lydrup M.L., Lynch A.C., Martling A., Meijerink J., Mentha A., Merkel S., McDermott F.D., McGrath J.S., Nielsen M.B., Nieuwenhuijzen G.A.P., Nilsson P.J., Abraham-Nordling M., O'Connell P.R., Patsouras D., Poggioli G., Radwan R.W., Rasheed S., Rasmussen P.C., Rothbarth J., Rutten H.J.T., Sagar P.M., Schizas A.M.P., Shida D., Smart N.J., Solomon M.J., Sorensen M.M., Stocchi L., Tekkis P.P., Tsukamoto S., Turner W.H., Tuynman J.B., van Ramshorst G.H., van Zoggel D., Vasquez-Jimenez W., Verhoef C., Verstegen M., Wakeman C., Warrier S., Yip J., Winter D.C., and Jenkins J.T.

Subjects
Laparoscopic surgery, medicine.medical_specialty, medicine.medical_treatment, 03 medical and health sciences, Tumours of the digestive tract Radboud Institute for Health Sciences [Radboudumc 14], 0302 clinical medicine, Minimally invasive surgery, Surgical complication, medicine, Humans, Minimally Invasive Surgical Procedures, Pelvic Neoplasms, Robotic surgery, Neoplasm Staging, Surgical outcome, Pelvic exenteration, business.industry, Patient Selection, Mortality rate, Minimally Invasive Surgical Procedure, Surgery, Outcome and Process Assessment, Health Care, 030220 oncology & carcinogenesis, Relative risk, Meta-analysis, Cohort, 030211 gastroenterology & hepatology, business, Human
Abstract

BACKGROUND: Pelvic exenteration is potentially curative for locally advanced and recurrent pelvic cancers. Evolving technology has facilitated the use of minimally invasive surgical (MIS) techniques in selected cases. We aimed to compare outcomes between open and MIS pelvic exenteration.METHODS: A review of comparative studies was performed. Firstly, we evaluated the differences in surgical techniques with respect to operative time, blood loss, and margin status. Secondly, we assessed differences in 30-day morbidity and mortality rates, and length of hospital stay.RESULTS: Four studies that directly compared open and MIS exenteration were included. Analysis was performed on 170 patients; 78.1% (n = 133) had open pelvic exenteration, while 21.8% (n = 37) had a MIS exenteration. The median age for open exenteration was 57.7 years versus 63 years for MIS exenteration. Even though the operative time for MIS exenteration was 83 min longer (p CONCLUSION: MIS exenteration can be performed in highly selective cases, where there is favourable patient anatomy and tumour characteristics. When feasible, it is associated with reduced intra-operative blood loss, shorter length of hospital stay, and reduced morbidity.

Published
2018
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