Evaluation of outcomes of a new advanced cancer unit: Results of 47 cases
Colorectal Disease
; 24(SUPPL 1):113, 2022.
Article
in English
| EMBASE | ID: covidwho-1745943
ABSTRACT
Purpose/Background:
Pelvic exenteration (PE), or “beyond-TME” surgery has become an established treatment for locally-advanced, or recurrent colorectal cancer, with the aim of achieving a complete (R0) resection and improve survival. We have established a regional centre for the management of advanced colorectal cancer and pelvic sarcoma. Methods/Interventions:
This was a retrospective, observational study using electronic health records (EHR). Patients were identified from a prospectively managed database and from multi-disciplinary team minutes. Data was gathered for 47 patients operated on by our Advanced Cancer service between November 2016 and March 2021 by four surgeons. EHR were searched for tumour and operation characteristics, complications, survival, oncological and recurrence data. During the COVID-19 pandemic, some patients had their operations at a separate, private hospital. Eligible patients were those that had pelvic exenteration (defined as removal of colon/rectum with additional organs such as bladder, prostate, vagina, sacrum, kidney), or large pelvic dissection for sarcoma. Results/Outcomes:
47 patients (23 male, 24 female) underwent operation, with a median age of 64 and ASA II. 33 (70%) patients presented with a primary tumour and 14 with a recurrent tumour. 37 (79%) had a locally advanced rectal or sigmoid cancer, 2 (4%) anal cancers, 2 gastro-intestinal stromal tumours and 6 (13%) pelvic sarcomas. One patient with recurrent rectal cancer had inoperable disease found at time of surgery so proceeded with only a palliative resection. Resection type is presented in Table 1. 43 patients had recorded status for margins, of which 33 (77%) had R0 resection and 10 (23%) R1. Mean operating time was 499 minutes (range 130-1020). Median time in critical care post-op was 2.5 days (IQR 1-6) and length of stay 13 days (IQR 13-20.5). 30-day Clavien-Dindo complications were none (15, 32%), Grade I/II (17, 36%), Grade III (6, 13%), Grade IV (8, 17%). One patient operated on in the independent sector could not have inpatient records assessed. 10 patients had a return to theatre, the majority (5) for wound washout, 1 for each of the following indications replacement of ureteric stent, ureteric reimplantation, revision of ischaemic colostomy, revision of flap, planned return for removal of haemostatic packs. There was no 90 day mortality. At a median of 25.6 months follow-up, 32 (68%) patients remain alive. In the 15 patients who have died, the mean time to death from procedure was 16.7 months. Recurrence was seen in 11 (23%) patients, of which 6 (13%) were distant, 3 (6%) local and 2 (4%) both. Conclusion/Discussion:
This data shows that it is possible to set up a new advanced cancer unit and achieve outcomes, in terms of mortality, margin status and recurrence that are comparable with those previously published by other centres during their set-up phase. (Table Presented).
adult; advanced cancer; anus cancer; bladder; cancer patient; cancer recurrence; cancer surgery; cancer survival; clinical article; clinical assessment; colorectal cancer; colostomy; complication; conference abstract; controlled study; coronavirus disease 2019; dissection; electronic health record; female; follow up; gastrointestinal stromal tumor; hospital patient; human; intensive care; kidney; length of stay; male; middle aged; mortality; multidisciplinary team; observational study; operation duration; outcome assessment; pandemic; pelvis cancer; pelvis exenteration; primary tumor; private hospital; prospective study; prostate; rectum cancer; reimplantation; retrospective study; sacrum; sarcoma; sigmoid cancer; surgeon; surgery; tumor recurrence; ureter stent; vagina; wound
Full text:
Available
Collection:
Databases of international organizations
Database:
EMBASE
Type of study:
Experimental Studies
Language:
English
Journal:
Colorectal Disease
Year:
2022
Document Type:
Article
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