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Review
. 2017 Nov;30(5):404-414.
doi: 10.1055/s-0037-1606118. Epub 2017 Dec 1.

Locally Advanced Disease and Pelvic Exenterations

Christos Kontovounisios  1   2 , Paris Tekkis  1   2
Affiliations
Review

Locally Advanced Disease and Pelvic Exenterations

Christos Kontovounisios et al. Clin Colon Rectal Surg. 2017 Nov.

Abstract

Advanced primary and recurrent colorectal cancer can be successfully treated by experienced, dedicated centers delivering good outcomes with low mortality and morbidity. Development and implementation of a comprehensive referral pathway is to be encouraged. Multidisciplinary team management is essential in the management of this complex group of patients and is associated with significantly more complete preoperative evaluation and more accurate provision of patient information, as well as improved access to the most appropriate individualized management plan. A structured selection process can improve outcomes through standardized approaches to service delivery to provide the highest quality of care.

Keywords: beyond total mesorectal excision; multidisciplinary management; primary advanced rectal cancer; recurrent rectal cancer.

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Figures

Fig. 1
Fig. 1
Algorithm to diagnose and assess resectability of primary rectal cancer beyond total mesorectal excision planes (PRC-bTME). Boxes with shading represent areas of particular controversy. CEA, Carcinoembryonic antigen; CT, computed tomography; EUS, examination under anesthesia; FDG; fluorodeoxyglucose; MRI, magnetic resonance imaging; PET, positron emission tomography; sMDT, specialist multidisciplinary team; TAP, thorax, abdomen, and pelvis.
Fig. 2
Fig. 2
Algorithm to diagnose and assess resectability of recurrent rectal cancer (RRC). Boxes with shading represent areas of particular controversy. CEA, Carcinoembryonic antigen; CT, computed tomography; EUS, examination under anesthesia; FDG, fluorodeoxyglucose; MRI, magnetic resonance imaging; PET, positron emission tomography; sMDT, specialist multidisciplinary team; TAP, thorax, abdomen, and pelvis.
Fig. 3
Fig. 3
Pelvic compartments: sagittal view (blue, rectovesical pouch; green, posterior; brown, central; purple, inferior).
Fig. 4
Fig. 4
Pelvic compartments: coronal view (yellow, lateral; green, posterior; brown, central).
Fig. 5
Fig. 5
Three-year disease-free survival for R0, R1, and R2 resection ( p  < 0.001).
Fig. 6
Fig. 6
Three-year disease-free survival for locally advanced primary cancer and recurrent rectal cancer after R0 resection ( p  = 0.212).
Fig. 7
Fig. 7
Three-year local recurrence free survival after R0 and R1 resection ( p  = 0.001).
Fig. 8
Fig. 8
Three-year local recurrence free survival for locally advanced primary cancer and recurrent rectal cancer after R0 resection ( p  = 0.780).
Fig. 9
Fig. 9
Double-barreled colostomy.
See this image and copyright information in PMC

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