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2. Simultaneous pelvic exenteration and liver resection for primary rectal cancer with synchronous liver metastases: results from the PelvEx Collaborative

Author

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., 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., Chong, P. C., 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., 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., 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. Ø., 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., 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., van Ramshorst, G. H., 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, É. 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., Hellawell, G., Shida, D., Simpson, A., Smart, N. J., Smart, P., Smith, J. J., Solbakken, A. M., Solomon, M. J., Sørensen, M. M., Steele, S. R., Steffens, D., Stitzenberg, K., Stocchi, L., Stylianides, N. A., Sumrien, H., Sutton, P. A., Swartking, T., 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., 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., de Wilt, J. H. W., Wolthuis, A., Yano, H., Yip, B., Yip, J., Yoo, R. N., van Zoggel, D., Winter, D. C., 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., 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., Chong, P. C., 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., 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., 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. Ø., 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., 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., van Ramshorst, G. H., 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, É. 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., Hellawell, G., Shida, D., Simpson, A., Smart, N. J., Smart, P., Smith, J. J., Solbakken, A. M., Solomon, M. J., Sørensen, M. M., Steele, S. R., Steffens, D., Stitzenberg, K., Stocchi, L., Stylianides, N. A., Sumrien, H., Sutton, P. A., Swartking, T., 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., 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., de Wilt, J. H. W., Wolthuis, A., Yano, H., Yip, B., Yip, J., Yoo, R. N., van Zoggel, D., Winter, D. C., Kelly, ME, Aalbers, AGJ, Aziz, NA, Abecasis, N, Abraham-Nordling, M, Akiyoshi, T, Alberda, W, Albert, M, Andric, M, Angenete, E, Antoniou, A, Auer, R, Austin, KK, Aziz, O, Baker, RP, Bali, M, Baseckas, G, Bebington, B, Bednarski, BK, Beets, GL, Berg, PL, Beynon, J, Biondo, S, Boyle, K, Bordeianou, L, Bremers, AB, Brunner, M, Buchwald, P, Bui, A, Burgess, A, Burger, JWA, Burling, D, Burns, E, Campain, N, Carvalhal, S, Castro, L, Caycedo-Marulanda, A, Chan, KKL, Chew, GJH, Chong, PC, Christensen, HK, Clouston, H, Codd, M, Coffins, D, Colquhoun, AJ, Corr, A, Coscia, M, Coyne, PE, Creavin, B, Croner, RS, Damjanovic, L, Daniels, R, Davies, M, Davies, RJ, Delaney, CP, Denost, Q, Deutsch, C, Dietz, D, Domingo, S, Dozois, EJ, Duff, M, Eglinton, T, Enrique-Navascues, JM, Espin-Basany, E, Evans, MD, Fearnhead, NS, Flatmark, K, Fleming, F, Frizelle, FA, Gallego, MA, Garcia-Granero, E, Garcia-Sabrido, JL, Gentilini, L, George, ML, Ghouti, L, Giner, F, Ginther, N, Glynn, R, Golda, T, Griffiths, B, Harris, DA, Hagemans, JAW, Hanchanale, V, Harji, DP, Helewa, RM, Heriot, AG, Hochman, D, Hohenberger, W, Holm, T, Hompes, R, Jenkins, JT, Kaffenberger, S, Kandaswamy, GV, Kapur, S, Kanemitsu, Y, Kelley, SR, Keller, DS, Khan, MS, Kiran, RP, Kim, H, Kim, HJ, Koh, CE, Kok, NFM, Kokelaar, R, Kontovounisios, C, Kristensen, HO, Kroon, HM, Kusters, M, Lago, V, Larsen, SG, Larson, DW, Law, WL, Laurberg, S, Lee, PJ, Limbert, M, Lydrup, ML, Lyons, A, Lynch, AC, Mantyh, C, Mathis, KL, Margues, CFS, Martling, A, Meijerink, WJHJ, Merkel, S, Mehta, AM, McArthur, DR, McDermott, FD, McGrath, JS, Malde, S, Mimezami, A, Monson, JRT, Morton, JR, Mullaney, TG, Negoi, I, Neto, JWM, Nguyen, B, Nielsen, MB, Nieuwenhuijzen, GAP, Nilsson, PJ, O'Connell, PR, O'Dwyer, ST, Palmer, G, Pappou, E, Park, J, Patsouras, D, Pellino, G, Peterson, AC, Poggioli, G, Proud, D, Quinn, M, Quyn, A, Radwan, RW, van Ramshorst, GH, Rasheed, S, Rasmussen, PC, Regenbogen, SE, Renehan, A, Rocha, R, Rochester, M, Rohila, J, Rothbarth, J, Rottoli, M, Roxburgh, C, Rutten, HJT, Ryan, EJ, Safar, B, Sagar, PM, Sahai, A, Saklani, A, Sammour, T, Sayyed, R, Schizas, AMP, Schwarzkopf, E, Scripcariu, V, Selvasekar, C, Shaikh, I, Hellawell, G, Shida, D, Simpson, A, Smart, NJ, Smart, P, Smith, JJ, Solbakken, AM, Solomon, MJ, Sorensen, MM, Steele, SR, Steffens, D, Stitzenberg, K, Stocchi, L, Stylianides, NA, Sumrien, H, Sutton, PA, Swanking, T, Taylor, C, Tekkis, PP, Teras, J, Thurairaja, R, Toh, EL, Tsarkov, P, Tsukada, Y, Tsukamoto, S, Tuech, JJ, Turner, WH, Tuynman, JB, Vasquez-Jimenez, W, Verhoef, C, Vizzielli, G, Voogt, ELK, Uehara, K, Wakeman, C, Warner, S, Wasmuth, HH, Weber, K, Weiser, MR, Wheeler, JMD, Wild, J, Wilson, M, de Wilt, JHW, Wolthuis, A, Yano, H, Yip, B, Yip, J, Yoo, RN, van Zoggel, D, Winter, DC, Surgery, CCA - Cancer Treatment and quality of life, and Amsterdam Gastroenterology Endocrinology Metabolism

Subjects
Male, medicine.medical_specialty, Adolescent, Colorectal cancer, survival outcomes, medicine.medical_treatment, surgical outcome, surgical outcomes, 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, Interquartile range, medicine, Humans, liver metastasi, Rectal cancer, Retrospective Studies, Pelvic exenteration, business.industry, Rectal Neoplasms, Mortality rate, Liver Neoplasms, Gastroenterology, Postoperative complication, Perioperative, medicine.disease, Surgery, Pelvic Exenteration, liver metastasis, Treatment Outcome, 030220 oncology & carcinogenesis, international collaboration, Resection margin, 030211 gastroenterology & hepatology, Hepatectomy, Neoplasm Recurrence, Local, business
Abstract

Aim: At presentation, 15–20% of patients with rectal cancer already have synchronous liver metastases. The aim of this study was to determine the surgical and survival outcomes in patients with advanced rectal cancer who underwent combined pelvic exenteration and liver (oligometastatic) resection. Method: Data from 20 international institutions that performed simultaneous pelvic exenteration and liver resection between 2007 and 2017 were accumulated. Primarily, we examined perioperative outcomes, morbidity and mortality. We also assessed the impact that margin status had on survival. Results: Of 128 patients, 72 (56.2%) were men with a median age of 60 years [interquartile range (IQR) 15 years]. The median size of the liver oligometastatic deposits was 2 cm (IQR 1.8 cm). The median duration of surgery was 406 min (IQR 240 min), with a median blood loss of 1090 ml (IQR 2010 ml). A negative resection margin (R0 resection) was achieved in 73.5% of pelvic exenterations and 66.4% of liver resections. The 30-day mortality rate was 1.6%, and 32% of patients had a major postoperative complication. The 5-year overall survival for patients in whom an R0 resection of both primary and metastatic disease was achieved was 54.6% compared with 20% for those with an R1/R2 resection (P = 0.006). Conclusion: Simultaneous pelvic exenteration and liver resection is feasible, with acceptable morbidity and mortality. Simultaneous resection should only be performed where an R0 resection of both pelvic and hepatic disease is anticipated.

Published
2020
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3. Management strategies for patients with advanced rectal cancer and liver metastases using modified Delphi methodology: results from the PelvEx Collaborative

Author

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., 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., Campain N., Carvalhal S., Castro L., Caycedo-Marulanda A., Kkl C., Chang G. J., Chew M. H., 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., de Wilt J., 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., 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., 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., Nfm K., 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., 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., Nguyen B., Nielsen M. B., Gap N., Nilsson P. J., 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., 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., 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., Sumrien H., Sutton P. A., Swartking T., 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., 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., Winter D. C., Rottoli M, Poggioli G, 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., 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., Campain, N., Carvalhal, S., Castro, L., Caycedo-Marulanda, A., Kkl, C., Chang, G. J., Chew, M. H., 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., de Wilt, J., 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., 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., 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., Nfm, K., 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., 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., Nguyen, B., Nielsen, M. B., Gap, N., Nilsson, P. J., 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., 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., 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., Sumrien, H., Sutton, P. A., Swartking, T., 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., 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., Winter, D. C., and Academic Medical Center

Subjects
Liver metastasisSurvival Outcome, medicine.medical_specialty, survival outcomes, Colorectal cancer, surgical outcome, medicine.medical_treatment, Delphi method, Rectum, Disease, surgical outcomes, 03 medical and health sciences, Liver disease, 0302 clinical medicine, SDG 3 - Good Health and Well-being, Hepatectomy, Humans, Medicine, liver metastasi, Rectal cancer, Neoplasm Staging, Pelvic exenteration, Rectal Neoplasms, business.industry, General surgery, Liver Neoplasms, Gastroenterology, Induction chemotherapy, medicine.disease, liver metastasis, medicine.anatomical_structure, 030220 oncology & carcinogenesis, international collaboration, 030211 gastroenterology & hepatology, business
Abstract

Aim: A total of 15–20% of patients with rectal cancer have liver metastases on presentation. The management of these patients is controversial. Heterogeneity in management strategies is considerable, with management often being dependent on local resources and available expertise. Method: Members of the PelvEx Collaborative were invited to participate in the generation of a consensus statement on the optimal management of patients with advanced rectal cancer with liver involvement. Fifteen statements were created for topical discussion on diagnostic and management issues. Panellists were asked to vote on statements and anonymous feedback was given. A collaborative meeting was used to discuss any nuances and clarify any obscurity. Consensus was considered when > 85% agreement on a statement was achieved. Results: A total of 135 participants were involved in the final round of the Delphi questionnaire. Nine of the 15 statements reached consensus regarding the management of patients with advanced rectal cancer and oligometastatic liver disease. Routine use of liver MRI was not recommended for patients with locally advanced rectal cancer, unless there was concern for metastatic disease on initial computed tomography staging scan. Induction chemotherapy was advocated as first-line treatment in those with synchronous liver metastases in locally advanced rectal cancer. In the presence of symptomatic primary disease, a diverting stoma may be required to facilitate induction chemotherapy. Overall, only one-quarter of the panellists would consider simultaneous pelvic exenteration and liver resection. Conclusion: This Delphi process highlights the diverse treatment of advanced rectal cancer with liver metastases and provides recommendations from an experienced international group regarding the multidisciplinary management approach.

Published
2020
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4. Contemporary management of locally advanced and recurrent rectal cancer: views from the PelvEx collaborative

Author

Kelly M. E., O’Sullivan N. J., Fahy M. R., Aalbers A. G. J., Abdul Aziz N., Abecasis N., Abraham-Nordling M., Abu Saadeh F., Akiyoshi T., Alberda W., Albert M., Andric M., Angeles M. A., Angenete E., Antoniou A., Auer R., Austin K. K., Aytac E., Aziz O., Bacalbasa N., Baker R. P., Bali M., Baransi S., Baseckas G., Bebington B., Bedford M., Bednarski B. K., Beets G. L., Berg P. L., Bergzoll C., Beynon J., Biondo S., Boyle K., Bordeianou L., Brecelj E., 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., Ceelen W., Chan K. K. L., Chang G. J., Chang M., Chew M. H., Chok A. Y., Chong P., Clouston H., Codd M., Collins D., Colquhoun A. J., Constantinides J., Corr A., Coscia M., Cosimelli M., Cotsoglou C., Coyne P. E., Croner R. S., Damjanovich L., Daniels I. R., Davies M., Delaney C. P., de Wilt J. H. W., Denost Q., Deutsch C., Dietz D., Domingo S., Dozois E. J., Drozdov E., Duff M., Eglinton T., Enriquez-Navascues J. M., Espín-Basany E., Evans M. D., Eyjólfsdóttir B., Fearnhead N. S., Ferron G., Fichtner-Feigl S., Flatmark K., Fleming F. J., Flor B., Folkesson J., Frizelle F. A., Funder J., Gallego M. A., Gargiulo M., García-Granero E., García-Sabrido J. L., Gava V. G., Gentilini L., George M. L., George V., Georgiou P., Ghosh A., Ghouti L., Gil-Moreno A., Giner F., Ginther D. N., Glyn T., Glynn R., Golda T., Griffiths B., Harris D. A., Hanchanale V., Harji D. P., Harris C., Helewa R. M., Hellawell G., Heriot A. G., Hochman D., HohenbergerW., Holm T., Hompes R., Hornung B., Hurton S., Hyun E., Ito M., Iversen L. H., Jenkins J. T., Jourand K., Kaffenberger S., Kandaswamy G. V., Kapur S., Kanemitsu Y., Kazi M., Kelley S. R., Keller D. S., Ketelaers S. H. J., Khan M. S., Kiran R. P., Kim H., Kim H. J., Koh C. E., Kok N. F. M., Kokelaar R., Kontovounisios C., Kose F., Koutra M., Kristensen H. Ø., Kroon H. M., Kumar S., Kusters M., Lago V., Lampe B., Lakkis Z., Larach J. T., Larkin J. O., Larsen S. G., Larson D. W., Law W. L., Lee P. J., Limbert M., Loria A., Lydrup ML., Lyons A., Lynch A. C., Maciel J., Manfredelli S., Mann C., Mantyh C., Mathis K. L., Marques C. F. S., Martinez A., Martling A., Mehigan B. J., MeijerinkW. J. H. J., Merchea A., Merkel S., Mehta A. M., Mikalauskas S., McArthur D. R., McCormick J. J., McCormick P., McDermott F. D., McGrath J. S., Malde S., Mirnezami A., Monson J. R. T., Navarro A. S., Neeff H., Negoi I., Neto J. W. M., Ng J. L., Nguyen B., Nielsen M. B., Nieuwenhuijzen G. A. P., Nilsson P. J., Nordkamp S., Nugent T., Oliver A., O’Dwyer S. T., Paarnio K., Palmer G., Pappou E., Park J., Patsouras D., Peacock O., Pellino G., Peterson A. C., Pfeffer F., Pinson J., Poggioli G., Proud D., Quinn M., Quyn A., Rajendran N., Radwan R. W., Rao C., Rasheed S., Rausa E., Regenbogen S. E., Reims H. M., Renehan A., Rintala J., Rocha R., Rochester M., Rohila J., Rothbarth J., Rottoli M., Roxburgh C., Rutten H. J. T., Safar B., Sagar P. M., Sahai A., Saklani A., Sammour T., Sayyed R., Schizas A. M. P., Schwarzkopf E., Scripcariu D., Scripcariu V., Selvasekar C., Shaikh I., Simpson A., Skeie-Jensen T., Smart N. J., Smart P., Smith J. J., Solbakken A. M., Solomon M. J., Sørensen M. M., Sorrentino L., Steele S. R., Steffens D., Stitzenberg K., Stocchi L., Stylianides N. A., Swartling T., Spasojevic M., Sumrien H., Sutton P. A., Swartking T., Takala H., Tan E. J., Taylor C., Taylor D., Tekin A., Tekkis P. P., Teras J., Thaysen H. V., Thurairaja R., Thorgersen E. B., Tiernan J., Toh E. L., Tolenaar J., Tsarkov P., Tsukada Y., Tsukamoto S., Tuech J. J., Turner W. H., Tuynman J. B., Valente M., van Ramshorst G. H., van Rees J., van Zoggel D., Vasquez-JimenezW., Vather R., Verhoef C., Vierimaa M., Vizzielli G., Voogt E. L. K., Uehara K., Urrejola G., Wakeman C., Warrier S. K., Wasmuth H. H., Waters P. S., Weber K., Weiser M. R., Wheeler J. M. D., Wild J., Williams A., Wilson M., Wolthuis A., Yano H., Yip B., Yoo R. N., Zappa M. A., Winter D. C., and Kelly M.E., O’Sullivan N.J., Fahy M.R., Aalbers A.G.J., Abdul Aziz N., Abecasis N., Abraham-Nordling M., Abu Saadeh F., Akiyoshi T., Alberda W., Albert M., Andric M., Angeles M.A., Angenete E., Antoniou A., Auer R., Austin K.K., Aytac E., Aziz O., Bacalbasa N., Baker R.P., Bali M., Baransi S., Baseckas G., Bebington B., Bedford M., Bednarski B.K., Beets G.L., Berg P.L., Bergzoll C., Beynon J., Biondo S., Boyle K., Bordeianou L., Brecelj E., 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., Ceelen W., Chan K.K.L., Chang G.J., Chang M., Chew M.H., Chok A.Y., Chong P., Clouston H., Codd M., Collins D., Colquhoun A.J., Constantinides J., Corr A., Coscia M., Cosimelli M., Cotsoglou C., Coyne P.E., Croner R.S., Damjanovich L., Daniels I.R., Davies M., Delaney C.P., de Wilt J.H.W., Denost Q., Deutsch C., Dietz D., Domingo S., Dozois E.J., Drozdov E., Duff M., Eglinton T., Enriquez-Navascues J.M., Espín-Basany E., Evans M.D., Eyjólfsdóttir B., Fearnhead N.S., Ferron G., Fichtner-Feigl S., Flatmark K., Fleming F.J., Flor B., Folkesson J., Frizelle F.A., Funder J., Gallego M.A., Gargiulo M., García-Granero E., García-Sabrido J.L., Gargiulo M., Gava V.G., Gentilini L., George M.L., George V., Georgiou P., Ghosh A., Ghouti L., Gil-Moreno A., Giner F., Ginther D.N., Glyn T., Glynn R., Golda T., Griffiths B., Harris D.A., Hanchanale V., Harji D.P., Harris C., Helewa R.M., Hellawell G., Heriot A.G., Hochman D., HohenbergerW., Holm T., Hompes R., Hornung B., Hurton S., Hyun E., Ito M., Iversen L.H., Jenkins J.T., Jourand K., Kaffenberger S., Kandaswamy G.V., Kapur S., Kanemitsu Y., Kazi M., Kelley S.R., Keller D.S., Ketelaers S.H.J., Khan M.S., Kiran R.P., Kim H., Kim H.J., Koh C.E., Kok N.F.M., Kokelaar R., Kontovounisios C., Kose F., Koutra M., Kristensen H.Ø., Kroon H.M., Kumar S., Kusters M., Lago V., Lampe B., Lakkis Z., Larach J.T., Larkin J.O., Larsen S.G., Larson D.W., Law W.L., Lee P.J., Limbert M., Loria A., Lydrup ML., Lyons A., Lynch A.C., Maciel J., Manfredelli S., Mann C., Mantyh C., Mathis K.L., Marques C.F.S., Martinez A., Martling A., Mehigan B.J., MeijerinkW.J.H.J., Merchea A., Merkel S., Mehta A.M., Mikalauskas S., McArthur D.R., McCormick J.J., McCormick P., McDermott F.D., McGrath J.S., Malde S., Mirnezami A., Monson J.R.T., Navarro A.S., Neeff H., Negoi I., Neto J.W.M., Ng J.L., Nguyen B., Nielsen M.B., Nieuwenhuijzen G.A.P., Nilsson P.J., Nordkamp S., Nugent T., Oliver A., O’Dwyer S.T., Paarnio K., Palmer G., Pappou E., Park J., Patsouras D., Peacock O., Pellino G., Peterson A.C., Pfeffer F., Pinson J., Poggioli G., Proud D., Quinn M., Quyn A., Rajendran N., Radwan R.W., Rajendran N., Rao C., Rasheed S., Rausa E., Regenbogen S.E., Reims H.M., Renehan A., Rintala J., Rocha R., Rochester M., Rohila J., Rothbarth J., Rottoli M., Roxburgh C., Rutten H.J.T., Safar B., Sagar P.M., Sahai A., Saklani A., Sammour T., Sayyed R., Schizas A.M.P., Schwarzkopf E., Scripcariu D., Scripcariu V., Selvasekar C., Shaikh I., Simpson A., Skeie-Jensen T., Smart N.J., Smart P., Smith J.J., Solbakken A.M., Solomon M.J., Sørensen M.M., Sorrentino L., Steele S.R., Steffens D., Stitzenberg K., Stocchi L., Stylianides N.A., Swartling T., Spasojevic M., Sumrien H., Sutton P.A., Swartking T., Takala H., Tan E.J., Taylor C., Taylor D., Tekin A., Tekkis P.P., Teras J., Thaysen H.V., Thurairaja R., Thorgersen E.B., Tiernan J., Toh E.L., Tolenaar J., Tsarkov P., Tsukada Y., Tsukamoto S., Tuech J.J., Turner W.H., Tuynman J.B., Valente M., van Ramshorst G.H., van Rees J., van Zoggel D., Vasquez-JimenezW., Vather R., Verhoef C., Vierimaa M., Vizzielli G., Voogt E.L.K., Uehara K., Urrejola G., Wakeman C., Warrier S.K.,Wasmuth H.H.,Waters P.S.,Weber K.,Weiser M.R., Wheeler J.M.D.,Wild J., Williams A., Wilson M., Wolthuis A., Yano H., Yip B., Yoo R.N., Zappa M.A., Winter D.C.

Subjects
Cancer Research, perioperative care, ENHANCED RECOVERY, diagnostic, EXENTERATION, surgical management, surgical outcomes, recurrent rectal cancer, SDG 3 - Good Health and Well-being, locally advanced rectal cancer, QUALITY-OF-LIFE, Medicine and Health Sciences, diagnostics, 1112 Oncology and Carcinogenesis, PATHOLOGICAL COMPLETE RESPONSE, rectal cancer, SURGICAL TECHNIQUES, OUTCOMES, Science & Technology, HYPERTHERMIC INTRAPERITONEAL, PelvEx Collaborative, CHEMOTHERAPY, WHOLE-BODY MRI, NEOADJUVANT CHEMORADIOTHERAPY, Oncology, quality of life, CYTOREDUCTIVE SURGERY, HYPERTHERMIC INTRAPERITONEAL CHEMOTHERAPY, Life Sciences & Biomedicine
Abstract

Pelvic exenteration is a complex operation performed for locally advanced and recurrent pelvic cancers. The goal of surgery is to achieve clear margins, therefore identifying adjacent or involved organs, bone, muscle, nerves and/or vascular structures that may need resection. While these extensive resections are potentially curative, they can be associated with substantial morbidity. Recently, there has been a move to centralize care to specialized units, as this facilitates better multidisciplinary care input. Advancements in pelvic oncology and surgical innovation have redefined the boundaries of pelvic exenterative surgery. Combined with improved neoadjuvant therapies, advances in diagnostics, and better reconstructive techniques have provided quicker recovery and better quality of life outcomes, with improved survival This article provides highlights of the current management of advanced pelvic cancers in terms of surgical strategy and potential future developments.

Published
2022
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5. Perioperative management and anaesthetic considerations in pelvic exenterations using Delphi methodology: results from the PelvEx Collaborative

Author

PelvEx Collaborative, [missing], Chok, A Y, Oliver, A, Rasheed, S, Tan, E J, 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, 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, de 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, Hellawell, G, Heriot, A G, Hochman, D, Hohenberger, W, Holm, T, Holmström, A, 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, Kok, N F M, Kokelaar, R, Kontovounisios, C, Kristensen, H Ø, 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, 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, Rutten, H J T, Ryan, É 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, Shida, D, Simpson, A, Smart, N J, Smart, P, Smith, J J, Solbakken, A M, Solomon, M J, Sørensen, M M, Steele, S R, Steffens, D, Stitzenberg, K, Stocchi, L, Stylianides, N A, Swartling, T, Sumrien, H, Sutton, P A, Swartking, T, 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, Gabriëlle, Zoggel, D van, 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, Tekkis, P P, Surgery, Chok, A Y, Oliver, A, Rasheed, S, Tan, E J, 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, 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, de 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, Hellawell, G, Heriot, A G, Hochman, D, Hohenberger, W, Holm, T, Holmström, A, 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, Kok, N F M, Kokelaar, R, Kontovounisios, C, Kristensen, H Ø, 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, 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, Rutten, H J T, Ryan, É 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, Shida, D, Simpson, A, Smart, N J, Smart, P, Smith, J J, Solbakken, A M, Solomon, M J, Sørensen, M M, Steele, S R, Steffens, D, Stitzenberg, K, Stocchi, L, Stylianides, N A, Swartling, T, Sumrien, H, Sutton, P A, Swartking, T, Taylor, C, Teras, J, Thurairaja, R, Toh, E L, Tsarkov, P, Tsukada, Y, Tsukamoto, S, Tuech, J J, Turner, W H, Tuynman, J B, Ramshorst, G H van, Zoggel, D van, 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, Tekkis, P P, Mcarthur, D R, Mcdermott, F D, Mcgrath, J S, Psychiatrie & Neuropsychologie, RS: MHeNs - R1 - Cognitive Neuropsychiatry and Clinical Neuroscience, RS: GROW - R3 - Innovative Cancer Diagnostics & Therapy, Faculteit FHML Centraal, Health Services Research, RS: CAPHRI - R1 - Ageing and Long-Term Care, RS: FdR IC Goederenrecht, School Office GROW, and Amsterdam Gastroenterology Endocrinology Metabolism

Subjects
BLOOD-TRANSFUSION, CARDIAC RISK, AcademicSubjects/MED00910, medicine.medical_treatment, Delphi method, Computer-assisted web interviewing, Tumours of the digestive tract Radboud Institute for Health Sciences [Radboudumc 14], 0302 clinical medicine, 030202 anesthesiology, Multidisciplinary approach, Medicine and Health Sciences, Medicine, humans, RISK, COMPLICATIONS, Perioperative management - anaesthetic - pelvic exenterations - rectal cancer - Delphi - PelvEx Collaborative, Manchester Cancer Research Centre, General Medicine, SYSTEMIC INFLAMMATORY RESPONSE, 030220 oncology & carcinogenesis, Original Article, Medical emergency, EPIDURAL-ANESTHESIA, AcademicSubjects/MED00010, Life Sciences & Biomedicine, Consensus, ENHANCED RECOVERY, Best practice, education, MEDLINE, patient care team/organization & administration, 03 medical and health sciences, anesthetics, Humans, MAJOR ABDOMINAL-SURGERY, METAANALYSIS, RECTAL-CANCER, Anesthetics, Patient Care Team, Science & Technology, Pelvic exenteration, business.industry, ResearchInstitutes_Networks_Beacons/mcrc, MORTALITY, LONG-TERM SURVIVAL, Perioperative, COMPARTMENT SYNDROME, medicine.disease, pelvic exenteration, Pelvic Exenteration, Subject-matter expert, consensus, Surgery, business
Abstract

Background The multidisciplinary perioperative and anaesthetic management of patients undergoing pelvic exenteration is essential for good surgical outcomes. No clear guidelines have been established, and there is wide variation in clinical practice internationally. This consensus statement consolidates clinical experience and best practice collectively, and systematically addresses key domains in the perioperative and anaesthetic management. Methods The modified Delphi methodology was used to achieve consensus from the PelvEx Collaborative. The process included one round of online questionnaire involving controlled feedback and structured participant response, two rounds of editing, and one round of web-based voting. It was held from December 2019 to February 2020. Consensus was defined as more than 80 per cent agreement, whereas less than 80 per cent agreement indicated low consensus. Results The final consensus document contained 47 voted statements, across six key domains of perioperative and anaesthetic management in pelvic exenteration, comprising preoperative assessment and preparation, anaesthetic considerations, perioperative management, anticipating possible massive haemorrhage, stress response and postoperative critical care, and pain management. Consensus recommendations were developed, based on consensus agreement achieved on 34 statements. Conclusion The perioperative and anaesthetic management of patients undergoing pelvic exenteration is best accomplished by a dedicated multidisciplinary team with relevant domain expertise in the setting of a specialized tertiary unit. This consensus statement has addressed key domains within the framework of current perioperative and anaesthetic management among patients undergoing pelvic exenteration, with an international perspective, to guide clinical practice, and has outlined areas for future clinical research., The PelvEx Collaborative consensus statement systematically addresses the perioperative and anaesthetic management of patients undergoing pelvic exenteration (PE). Using the modified Delphi methodology, recommendations across six key clinical domains comprising preoperative assessment and preparation, anaesthetic considerations, perioperative management, anticipating possible massive haemorrhage, stress response and postoperative critical care, and pain management were developed. pelvic exenteratio and recommendation

Published
2021
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6. 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

7. 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

11. Changing outcomes following pelvic exenteration for locally advanced and recurrent rectal cancer

Author

Kelly, M. E., Aalbers, A. G. J., Aziz, N. Abdul, Abraham-Nordling, M., Alberda, W., Antoniou, A., Austin, K. K., Baker, R., 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., Chew, M. H., Chong, P. C., 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., Deutsch, C., Dietz, D., Dozois, E. J., Duff, M., Eglinton, T., Evans, 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., Hagemans, J. A. W., Harji, D. P., Harris, D. A., Heriot, A. A. G., Hohenberger, W., Holm, T., Jenkins, J. T., Kanemitsu, Y., Kapur, S., Keller, D. S., Kelley, S. R., Kim, H., Koh, C. E., Kok, N. F. M., Kokelaar, R., Kontovounisios, C., Kusters, M., Larson, D. W., Laurberg, S., Law, W. L., Lee, P., Lydrup, M. L., Lynch, A. C., Martling, A., Mathis, K. L., Meijerink, W. J. H. J., Mentha, A. M., Merkel, S., McDermott, F. D., McGrath, J. S., Mihailo, A., Mirnezami, A., Morton, J. R., Mullaney, T. G., 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., Rocha, R., Rothbarth, J., Roxburgh, C., Rutten, H. J. T., Ryan, E., Sagar, P. M., Sammour, T., Schizas, A. M. P., Schwarzkopf, E., Scripcariu, V, Shaikh, I, Shida, D., Simpson, A., Smart, N. J., Smith, J., Solomon, M. J., Sorensen, M. M., Steele, S. R., Steffens, D., Stocchi, L., Stylianides, N. A., Taylor, C., Tekkis, P. P., Tsukamoto, S., Turner, W. H., Tuynman, J. B., van Ramshorst, Gabriëlle, 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., Winter, D. C., Yip, J., Kelly, M. E., Aalbers, A. G. J., Aziz, N. Abdul, Abraham‐Nordling, M., Alberda, W., Antoniou, A., Austin, K. K., Baker, R., 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., Chew, M. H., Chong, P. C., 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., Wilt, J. H. W., Denost, Q., Deutsch, C., Dietz, D., Dozois, E. J., Duff, M., Eglinton, T., Evans, 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., Hagemans, J. A.W., Harji, D. P., Harris, D. A., Heriot, A. A. G., Hohenberger, W., Holm, T., Jenkins, J. T., Kanemitsu, Y., Kapur, S., Keller, D. S., Kelley, S. R., Kim, H., Koh, C. E., Kok, N. F. M., Kokelaar, R., Kontovounisios, C., Kusters, M., Larson, D. W., Laurberg, S., Law, W. L., Lee, P., Lydrup, M. L., Lynch, A. C., Martling, A., Mathis, K. L., Meijerink, W. J. H. J., Mentha, A. M., Merkel, S., McDermott, F. D., McGrath, J. S., Mihailo, A., Mirnezami, A., Morton, J. R., Mullaney, T. G., 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., Rocha, R., Rothbarth, J., Roxburgh, C., Rutten, H. J. T., Ryan, É., Sagar, P. M., Sammour, T., Schizas, A. M. P., Schwarzkopf, E., Scripcariu, V., Shaikh, I., Shida, D., Simpson, A., Smart, N. J., Smith, J., Solomon, M. J., Sørensen, M.M., Steele, S. R., Steffens, D., Stocchi, L., Stylianides, N. A., Taylor, C., Tekkis, P. P., Tsukamoto, S., Turner, W. H., Tuynman, J. B., Ramshorst, G. H., 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., Winter, D. C., Yip, J., Kelly, Me, Aalbers, Agj, Aziz, Na, Abraham-Nordling, M, Alberda, W, Antoniou, A, Austin, Kk, Baker, R, 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, G, Chew, Mh, Chong, Pc, 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, Deutsch, C, Dietz, D, Dozois, Ej, Duff, M, Eglinton, T, Evans, M, Evans, Md, Fearnhead, N, Frizelle, Fa, Garcia-Granero, E, Garcia-Sabrido, Jl, Gentilini, L, George, Ml, Glynn, R, Golda, T, Griffiths, B, Hagemans, Jaw, Harji, Dp, Harris, Da, Heriot, Aag, Hohenberger, W, Holm, T, Jenkins, Jt, Kanemitsu, Y, Kapur, S, Keller, D, Kelley, Sr, Kim, H, Koh, Ce, Kok, Nfm, Kokelaar, R, Kontovounisios, C, Kusters, M, Larson, Dw, Laurberg, S, Law, Wl, Lee, P, Lydrup, Ml, Lynch, Ac, Martling, A, Mathis, Kl, Meijerink, Wjhj, Mentha, Am, Merkel, S, Mcdermott, Fd, Mcgrath, J, Mihailo, A, Mirnezami, A, Morton, Jr, Mullaney, Tg, 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, Rocha, R, Rothbarth, J, Roxburgh, C, Rutten, Hjt, Ryan, E, Sagar, Pm, Sammour, T, Schizas, Amp, Schwarzkopf, E, Scripcariu, V, Shaikh, I, Shida, D, Simpson, A, Smart, Nj, Smith, J, Solomon, Mj, Sorensen, Mm, Steele, Sr, Steffens, D, Stocchi, L, Stylianides, Na, Taylor, C, Tekkis, Pp, 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, Winter, Dc, and Yip, J

Subjects
Male, Blood transfusion, Colorectal cancer, medicine.medical_treatment, Surgical Flaps, COLORECTAL-CANCER, Tumours of the digestive tract Radboud Institute for Health Sciences [Radboudumc 14], Postoperative Complications, Retrospective Studie, Medicine and Health Sciences, Mortality rate, General Medicine, Middle Aged, Treatment Outcome, medicine.anatomical_structure, HOSPITAL VOLUME, SURVIVAL, Original Article, Female, Life Sciences & Biomedicine, Human, medicine.medical_specialty, lcsh:Surgery, Rectum, Subgroup analysis, SDG 3 - Good Health and Well-being, medicine, Humans, Blood Transfusion, Retrospective Studies, Aged, Science & Technology, Pelvic exenteration, Rectal Neoplasms, business.industry, MORTALITY, PelvEx Collaborative, Retrospective cohort study, Original Articles, lcsh:RD1-811, Length of Stay, medicine.disease, SURGEON VOLUME, Pelvic Exenteration, Surgery, Surgical Flap, Postoperative Complication, Neoplasm Recurrence, Local, business, Complication
Abstract

Contains fulltext : 215764.pdf (Publisher’s version ) (Open Access) Background: Pelvic exenteration for locally advanced rectal cancer (LARC) and locally recurrent rectal cancer (LRRC) is technically challenging but increasingly performed in specialist centres. The aim of this study was to compare outcomes of exenteration over time. Methods: This was a multicentre retrospective study of patients who underwent exenteration for LARC and LRRC between 2004 and 2015. Surgical outcomes, including rate of bone resection, flap reconstruction, margin status and transfusion rates, were examined. Outcomes between higher- and lower-volume centres were also evaluated. Results: Some 2472 patients underwent pelvic exenteration for LARC and LRRC across 26 institutions. For LARC, rates of bone resection or flap reconstruction increased from 2004 to 2015, from 3.5 to 12.8 per cent, and from 12.0 to 29.4 per cent respectively. Fewer units of intraoperative blood were transfused over this interval (median 4 to 2 units; P = 0.040). Subgroup analysis showed that bone resection and flap reconstruction rates increased in lower- and higher-volume centres. R0 resection rates significantly increased in low-volume centres but not in high-volume centres over time (low-volume: from 62.5 to 80.0 per cent, P = 0.001; high-volume: from 83.5 to 88.4 per cent, P = 0.660). For LRRC, no significant trends over time were observed for bone resection or flap reconstruction rates. The median number of units of intraoperative blood transfused decreased from 5 to 2.5 units (P < 0.001). R0 resection rates did not increase in either low-volume (from 51.7 to 60.4 per cent; P = 0.610) or higher-volume (from 48.6 to 65.5 per cent; P = 0.100) centres. No significant differences in length of hospital stay, 30-day complication, reintervention or mortality rates were observed over time. Conclusion: Radical resection, bone resection and flap reconstruction rates were performed more frequently over time, while transfusion requirements decreased.

Published
2019

12. The global cost of pelvic exenteration:in-hospital perioperative costs

Author

Kelly, M. E., Agj, Aalbers, 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, Burger, Burling, D., Burns, E., Campain, N., Carvalhal, S., Castro, L., Caycedo-Marulanda, A., Kkl, Chan, Chang, G. J., Chang, M., Chew, M. H., Chok, A. K., Chong, P., Christensen, H. K., Clouston, H., Codd, M., Collins, D., Colquhoun, A. J., Corr, A., Coscia, M., Cosimelli, M., Coyne, P. E., Croner, R. S., Damjanovic, L., Daniels, I. R., Davies, M., Davies, R. J., Delaney, C. P., Jhw, Wilt, 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., Eyjólfsdóttir, B., Fahy, M., Fearnhead, N. S., Flatmark, K., Fleming, F., Folkesson, J., 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, Hagemans, 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. J., Koh, C. E., Nfm, Kok, Kokelaar, R., Kontovounisios, C., Kristensen, H., Kroon, H. M., Kumar, S., Kusters, M., Lago, V., Lakkis, Z., 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, Margues, Martling, A., Wjhj, Meijerink, Merchea, A., Merkel, S., Mehta, A. M., McArthur, D. R., McDermott, F. D., McGrath, J. S., Malde, S., Mirnezami, A., Jrt, Monson, Morton, J. R., Mullaney, T. G., Negoi, I., Jwm, Neto, Ng, J. L., Nguyen, B., Nielsen, M. B., Gap, Nieuwenhuijzen, 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., Rajendran, N., Radwan, R. W., Rasheed, S., Rasmussen, P. C., Rausa, E., Regenbogen, S. E., Renehan, A., Rocha, R., Rochester, M., Rohila, J., Rothbarth, J., Rottoli, M., Roxburgh, C., Hjt, Rutten, Safar, B., Sagar, P. M., Sahai, A., Saklani, A., Sammour, T., Sayyed, R., Amp, Schizas, Schwarzkopf, E., Scripcariu, V., Selvasekar, C., Shaikh, I., Shida, D., Simpson, A., Skeie-Jensen, T., Smart, N. J., Smart, P., Smith, J. J., Solbakken, A. M., Solomon, M. J., Sørensen, 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., Elk, Voogt, Uehara, K., Wakeman, C., Warrier, S., Wasmuth, H. H., Weber, K., Weiser, M. R., Jmd, Wheeler, Wild, J., Wilson, M., Wolthuis, A., Yano, H., Yip, B., Yip, J., Yoo, R. N., Zappa, M. A., Winter, D. C., Kelly, M. E., Agj, Aalbers, 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, Burger, Burling, D., Burns, E., Campain, N., Carvalhal, S., Castro, L., Caycedo-Marulanda, A., Kkl, Chan, Chang, G. J., Chang, M., Chew, M. H., Chok, A. K., Chong, P., Christensen, H. K., Clouston, H., Codd, M., Collins, D., Colquhoun, A. J., Corr, A., Coscia, M., Cosimelli, M., Coyne, P. E., Croner, R. S., Damjanovic, L., Daniels, I. R., Davies, M., Davies, R. J., Delaney, C. P., Jhw, Wilt, 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., Eyjólfsdóttir, B., Fahy, M., Fearnhead, N. S., Flatmark, K., Fleming, F., Folkesson, J., 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, Hagemans, 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. J., Koh, C. E., Nfm, Kok, Kokelaar, R., Kontovounisios, C., Kristensen, H., Kroon, H. M., Kumar, S., Kusters, M., Lago, V., Lakkis, Z., 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, Margues, Martling, A., Wjhj, Meijerink, Merchea, A., Merkel, S., Mehta, A. M., McArthur, D. R., McDermott, F. D., McGrath, J. S., Malde, S., Mirnezami, A., Jrt, Monson, Morton, J. R., Mullaney, T. G., Negoi, I., Jwm, Neto, Ng, J. L., Nguyen, B., Nielsen, M. B., Gap, Nieuwenhuijzen, 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., Rajendran, N., Radwan, R. W., Rasheed, S., Rasmussen, P. C., Rausa, E., Regenbogen, S. E., Renehan, A., Rocha, R., Rochester, M., Rohila, J., Rothbarth, J., Rottoli, M., Roxburgh, C., Hjt, Rutten, Safar, B., Sagar, P. M., Sahai, A., Saklani, A., Sammour, T., Sayyed, R., Amp, Schizas, Schwarzkopf, E., Scripcariu, V., Selvasekar, C., Shaikh, I., Shida, D., Simpson, A., Skeie-Jensen, T., Smart, N. J., Smart, P., Smith, J. J., Solbakken, A. M., Solomon, M. J., Sørensen, 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., Elk, Voogt, Uehara, K., Wakeman, C., Warrier, S., Wasmuth, H. H., Weber, K., Weiser, M. R., Jmd, Wheeler, Wild, J., Wilson, M., Wolthuis, A., Yano, H., Yip, B., Yip, J., Yoo, R. N., Zappa, M. A., and Winter, D. C.

Published
2020

13. 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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20. 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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