Skip to main content
Key Specialties
Cardiology Diabetology Endocrinology Gastroenterology Geriatrics and Gerontology Gynecology and Obstetrics Hematology Infectious Disease Internal Medicine Nephrology Neurology Oncology Pediatrics Respiratory Medicine Rheumatology Surgery
Congress Coverage
2024 ACC Congress 2023 ESMO Congress 2023 EASD Congress 2023 ERS Congress 2023 ESC Congress 2023 EHA Congress 2023 ASCO Annual Meeting
Clinical Collections
Advances in Alzheimer’s

Keynote webinar | Spotlight on sleep in brain health

LIVE: Thursday 2nd May 2024, 18:00-19:30 (CEST)

Quality sleep is essential for health. But what happens to our brains when sleep patterns are disturbed? Join our experts to explore the interplay between sleep disruption and neurological diseases, and the questions that you need to be asking your patients to help you prevent the harmful effects of sleep deprivation.
ADVANCED SEARCH
Log in
Top
Langenbeck's Archives of Surgery
Published in: Langenbeck's Archives of Surgery 6/2021

01-09-2021 | Rectal Cancer | State-of-the-Art Clinical Surgery

State-of-the-art surgery for recurrent and locally advanced rectal cancers

Authors: Mufaddal Kazi, Vivek Sukumar, Ashwin Desouza, Avanish Saklani

Published in: Langenbeck's Archives of Surgery | Issue 6/2021

Login to get access

Abstract

Extended and beyond total mesorectal excisions (TME) for advanced and recurrent rectal cancers are increasingly performed with acceptable oncological and functional outcomes. These are undoubtedly due to better understanding of tumor biology and improved patient selection rather than surgical valor and technical refinements alone. In the present review, we attempt to present the current surgical standards for advanced and recurrent cancers requiring surgery outside the TME planes based on involved pelvic compartments. The available procedures, their indications, and extent of resection and reconstruction are highlighted. Emphasis is on formation of dedicated exenteration teams, structured training, and referral systems that increase hospital and surgeon volume to improve patient outcomes and reduce morbidity. Areas of deficiencies in literature were recognized with regards to factors influencing recurrences, patient selection, and quality of life. Finally, the most appropriate preoperative therapy for these tumors is unclear in both the primary and recurrent settings.
Literature
1.
Amshel C, Avital S, Miller A, Sands L, Marchetti F, Hellinger M (2005) T4 rectal cancer: analysis of patient outcome after surgical excision. Am Surg. 71:901–903 (discussion 904)PubMedCrossRef
2.
Patil PS, Saklani A, Gambhire P, Mehta S, Engineer R, De Souza A et al (2017) Colorectal cancer in India: an audit from a tertiary center in a low prevalence area. Indian J Surg Oncol. 8:484–490PubMedPubMedCentralCrossRef
3.
4.
Folkesson J, Birgisson H, Pahlman L, Cedermark B, Glimelius B, Gunnarsson U (2005) Swedish Rectal Cancer Trial: long lasting benefits from radiotherapy on survival and local recurrence rate. J Clin Oncol Off J Am Soc Clin Oncol 23:5644–5650CrossRef
5.
van Gijn W, Marijnen CAM, Nagtegaal ID, Kranenbarg EM-K, Putter H, Wiggers T et al (2011) Preoperative radiotherapy combined with total mesorectal excision for resectable rectal cancer: 12-year follow-up of the multicentre, randomised controlled TME trial. Lancet Oncol 12:575–582PubMedCrossRef
6.
Lopez-Kostner F, Fazio VW, Vignali A, Rybicki LA, Lavery IC (2001) Locally recurrent rectal cancer: predictors and success of salvage surgery. Dis Colon Rectum 44:173–178PubMedCrossRef
7.
Collaborative PelvEx (2019) Palliative pelvic exenteration: a systematic review of patient-centered outcomes. Eur J Surg Oncol J Eur Soc Surg Oncol Br Assoc Surg Oncol 45:1787–1795
8.
Heriot AG, Byrne CM, Lee P, Dobbs B, Tilney H, Solomon MJ et al (2008) Extended radical resection: the choice for locally recurrent rectal cancer. Dis Colon Rectum 51:284–291PubMedCrossRef
9.
Venchiarutti RL, Solomon MJ, Koh CE, Young JM, Steffens D (2019) Pushing the boundaries of pelvic exenteration by maintaining survival at the cost of morbidity. Br J Surg 106:1393–1403PubMedCrossRef
10.
Collaborative PelvEx (2019) Surgical and survival outcomes following pelvic exenteration for locally advanced primary rectal cancer: results from an international collaboration. Ann Surg 269:315–321CrossRef
11.
Kumar NA, Desouza A, Ostwal V, Sasi SP, Verma K, Ramaswamy A, et al. (2021) Outcomes of exenteration in cT4 and fixed cT3 stage primary rectal adenocarcinoma: a subgroup analysis of consolidation chemotherapy following neoadjuvant concurrent chemoradiotherapy. Langenbecks Arch Surg
12.
Kumar NA, Sasi SP, Shinde RS, Verma K, Sugoor P, Desouza A, et al. (2020) Minimally invasive surgery for pelvic exenteration in primary colorectal cancer. JSLS 24
13.
Rausa E, Kelly ME, Bonavina L, O’Connell PR, Winter DC (2017) A systematic review examining quality of life following pelvic exenteration for locally advanced and recurrent rectal cancer. Colorectal Dis 19:430–436PubMedCrossRef
14.
Beyond TME Collaborative (2013) Consensus statement on the multidisciplinary management of patients with recurrent and primary rectal cancer beyond total mesorectal excision planes. Br J Surg 100:1009–1014CrossRef
15.
Moreno CC, Sullivan PS, Kalb BT, Tipton RG, Hanley KZ, Kitajima HD et al (2015) Magnetic resonance imaging of rectal cancer: staging and restaging evaluation. Abdom Imaging 40:2613–2629PubMedCrossRef
16.
Kolev NY, Tonev AY, Ignatov VL, Zlatarov AK, Bojkov VM, Kirilova TD et al (2014) The role of 3-D endorectal ultrasound in rectal cancer: our experience. Int Surg 99:106–111PubMedPubMedCentralCrossRef
17.
18.
19.
Ould-Slimane M, Thong P, Perez A, Roussignol X, Dujardin F-H (2016) The role of Intraoperative 3D navigation for pelvic bone tumor resection. Orthop Traumatol Surg Res 102:807–811PubMedCrossRef
20.
van der Meij W, Rombouts AJM, Rütten H, Bremers AJA, de Wilt JHW (2016) Treatment of locally recurrent rectal carcinoma in previously (chemo)irradiated patients: a review. Dis Colon Rectum 59:148–156PubMedCrossRef
21.
Ng MKY, Leong T, Heriot AG, Ngan SYK (2013) Once-daily reirradiation for rectal cancer in patients who have received previous pelvic radiotherapy. J Med Imaging Radiat Oncol 57:512–518PubMedCrossRef
22.
Lee J, Kim CY, Koom WS, Rim CH (2019) Practical effectiveness of re-irradiation with or without surgery for locoregional recurrence of rectal cancer: a meta-analysis and systematic review. Radiother Oncol J Eur Soc Ther Radiol Oncol 140:10–19CrossRef
23.
Alberda WJ, Verhoef C, Nuyttens JJ, van Meerten E, Rothbarth J, de Wilt JHW et al (2014) Intraoperative radiation therapy reduces local recurrence rates in patients with microscopically involved circumferential resection margins after resection of locally advanced rectal cancer. Int J Radiat Oncol Biol Phys 88:1032–1040PubMedCrossRef
24.
25.
Tjandra JJ, Kilkenny JW, Buie WD, Hyman N, Simmang C, Anthony T et al (2005) Practice parameters for the management of rectal cancer (revised). Dis Colon Rectum 48:411–423PubMedCrossRef
26.
27.
Moore HG, Shoup M, Riedel E, Minsky BD, Alektiar KM, Ercolani M et al (2004) Colorectal cancer pelvic recurrences: determinants of resectability. Dis Colon Rectum 47:1599–1606PubMedCrossRef
28.
Suzuki K, Dozois RR, Devine RM, Nelson H, Weaver AL, Gunderson LL et al (1996) Curative reoperations for locally recurrent rectal cancer. Dis Colon Rectum 39:730–736PubMedCrossRef
29.
Georgiou PA, Tekkis PP, Constantinides VA, Patel U, Goldin RD, Darzi AW et al (1990) Diagnostic accuracy and value of magnetic resonance imaging (MRI) in planning exenterative pelvic surgery for advanced colorectal cancer. Eur J Cancer Oxf Engl 2013(49):72–81
30.
Pokharkar A, Kammar P, D’Souza A, Bhamre R, Sugoor P, Saklani A (2018) Laparoscopic pelvic exenteration for locally advanced rectal cancer, technique and short-term outcomes. J Laparoendosc Adv Surg Tech A. 28:1489–1494PubMedCrossRef
31.
Pokharkar A, Bankar S, Rohila J, Jaiswal D, deSouza A, Saklani A (2020) Laparoscopic posterior pelvic exenteration (complete and supralevator) for locally advanced adenocarcinoma of the rectum in females: surgical technique and short-term outcomes. J Laparoendosc Adv Surg Tech. Mary Ann Liebert, Inc., publishers; 1; 30: 558–563
32.
Bankar S, Pandey D, Sukumar V, Kumar BR, Pawar T, Rohila J et al (2020) Laparoscopic supralevator posterior exenteration in a case of previous laparoscopic ovarian transposition – a video vignette. Colorectal Dis 22:1470–1471PubMedCrossRef
33.
Kammar P, Sasi S, Kumar N, Rohila J, deSouza A, Saklani A (2019) Robotic posterior pelvic exenteration for locally advanced rectal cancer - a video vignette. Colorectal Dis Off J Assoc Coloproctology G B Irel 21:606
34.
Bhamre R, Pokharkar A, Shinde R, Saklani A (2018) Laparoscopic total pelvic exenteration for locally advanced carcinoma of the rectum - a video vignette. Colorectal Dis 20:161–162PubMedCrossRef
35.
Desouza AL, Raj Kumar B, Sasi S, Malpangudi S, Saklani AP (2021) Robotic total proctocolectomy with en masse total pelvic exenteration - a video vignette. Colorectal Dis Off J Assoc Coloproctology G B Irel 23:332
36.
Solomon MJ, Austin KKS, Masya L, Lee P (2015) Pubic bone excision and perineal urethrectomy for radical anterior compartment excision during pelvic exenteration. Dis Colon Rectum 58:1114–1119PubMedCrossRef
37.
Yamamoto S, Yamanaka N, Maeda T, Uchida Y, Yabe S, Nakano M et al (2001) Ileal neobladder for urinary bladder replacement following total pelvic exenteration for rectal carcinoma. Dig Surg 18:67–72PubMedCrossRef
38.
Kazi M, Rohila J, Kumar NA, Bankar S, Engineer R, Desouza A, et al. (2021) Urinary reconstruction following total pelvic exenteration for locally advanced rectal cancer: complications and factors affecting outcomes. Langenbecks Arch Surg [Internet]. [cited 2021 Feb 7]; Available from: https://​doi.​org/​10.​1007/​s00423-021-02086-z
39.
Verma K, Engineer R, Ostwal V, Kumar S, Arya S, Desouza AL et al (2018) Persistent involvement of anterior mesorectal fascia in carcinoma rectum – extended resection of rectum vs total pelvic exenteration: results from a single-centre retrospective study. Colorectal Dis 20:1070–1077PubMedCrossRef
40.
Desouza A, Sugoor P, Sasi S, Rohila J, Saklani A (2019) Robotic intersphincteric resection with right seminal vesicle excision via a right vascular approach using the Da Vinci Xi robotic system - a video vignette. Colorectal Dis Off J Assoc Coloproctology G B Irel 21:492–493
41.
Raj Kumar B, Bankar S, Pandey D, Rohila J, Prakash G, Bakshi G et al (2020) Abdominoperineal excision with prostatectomy in T4 rectal cancer - bladder-sparing robotic pelvic exenteration - a video vignette. Colorectal Dis Off J Assoc Coloproctology G B Irel 22:1786–1787
42.
Pai VD, Engineer R, Patil PS, Arya S, Desouza AL, Saklani AP (2016) Selective extra levator versus conventional abdomino perineal resection: experience from a tertiary-care center. J Gastrointest Oncol 7:354–359PubMedPubMedCentralCrossRef
43.
Han JG, Wang ZJ, Wei GH, Gao ZG, Yang Y, Zhao BC (2012) Randomized clinical trial of conventional versus cylindrical abdominoperineal resection for locally advanced lower rectal cancer. Am J Surg 204:274–282PubMedCrossRef
44.
Chavan RN, Saklani AP, Desouza AL, Rohila J, Kazi M, Sukumar V, et al. (2021) V-Y Gluteal advancement fasciocutaneous flap for reconstruction of perineal defects after surgery for anorectal cancers— a single-center experience. Indian J Surg Oncol [Internet]. [cited 2021 Apr 18]; Available from: https://​doi.​org/​10.​1007/​s13193-021-01311-x
45.
Kumar S, Rohila J, Sasi SP, Tantravahi U, K GD, Sharma V et al (2020) Robotic-assisted low anterior resection: beyond total mesorectal excision; a left vascular approach with presacral fascia excision - a video vignette. Colorectal Dis Off J Assoc Coloproctology G B Irel 22:595–596
46.
Bankar S, Pandey D, Sukumar V, Gori J, Suman A, Rohila J et al (2020) Laparoscopic low anterior resection with extended total mesorectal excision for locally advanced rectal cancer – a video vignette. Colorectal Dis 22:1763–1764PubMedCrossRef
47.
Pareekutty NM, Balasubramanian S, Kadam S, Jayaprakash D, Ankalkoti B, Nayanar S et al (2019) En bloc resection with partial sacrectomy helps to achieve R0 resection in locally advanced rectal cancer, experience from a tertiary cancer center. Indian J Surg Oncol 10:141–148PubMedPubMedCentralCrossRef
48.
Solomon MJ, Tan K-K, Bromilow RG, Al-mozany N, Lee PJ (2014) Sacrectomy via the abdominal approach during pelvic exenteration. Dis Colon Rectum 57:272–277PubMedCrossRef
49.
Colibaseanu DT, Dozois EJ, Mathis KL, Rose PS, Ugarte MLM, Abdelsattar ZM et al (2014) Extended sacropelvic resection for locally recurrent rectal cancer: can it be done safely and with good oncologic outcomes? Dis Colon Rectum 57:47–55PubMedCrossRef
50.
Evans MD, Harji DP, Sagar PM, Wilson J, Koshy A, Timothy J et al (2013) Partial anterior sacrectomy with nerve preservation to treat locally advanced rectal cancer. Colorectal Dis 15:e336–e339PubMedCrossRef
51.
Sasikumar A, Bhan C, Jenkins JT, Antoniou A, Murphy J (2017) Systematic review of pelvic exenteration with en bloc sacrectomy for recurrent rectal adenocarcinoma: R0 resection predicts disease-free survival. Dis Colon Rectum 60:346–352PubMedCrossRef
52.
Milne T, Solomon MJ, Lee P, Young JM, Stalley P, Harrison JD (2013) Assessing the impact of a sacral resection on morbidity and survival after extended radical surgery for locally recurrent rectal cancer. Ann Surg 258:1007–1013PubMedCrossRef
53.
Kim J (2012) Pelvic Exenteration: surgical approaches. J Korean Soc Coloproctology 28:286–293CrossRef
54.
Pereira P, Ghouti L, Gaichet V (2012) Extra-vascular dissection of the pelvic sidewall for advanced cancers of the pelvis A technique to obtain wider lateral resection margins. J Visc Surg. 149:307–313CrossRef
55.
Höckel M (2003) Laterally extended endopelvic resection. Novel surgical treatment of locally recurrent cervical carcinoma involving the pelvic side wall. Gynecol Oncol 91:369–377PubMedCrossRef
56.
Abdelsattar ZM, Mathis KL, Colibaseanu DT, Merchea A, Bower TC, Larson DW et al (2013) Surgery for locally advanced recurrent colorectal cancer involving the aortoiliac axis: can we achieve R0 resection and long-term survival? Dis Colon Rectum 56:711–716PubMedCrossRef
57.
Austin KKS, Solomon MJ (2009) Pelvic exenteration with en bloc iliac vessel resection for lateral pelvic wall involvement. Dis Colon Rectum 52:1223–1233PubMedCrossRef
58.
Austin KKS, Herd AJ, Solomon MJ, Ly K, Lee PJ (2016) Outcomes of pelvic exenteration with en bloc partial or complete pubic bone excision for locally advanced primary or recurrent pelvic cancer. Dis Colon Rectum 59:831–835PubMedCrossRef
59.
Lau YC, Brown KGM, Lee P (2019) Pelvic exenteration for locally advanced and recurrent rectal cancer-how much more? J Gastrointest Oncol 10:1207–1214PubMedPubMedCentralCrossRef
60.
Holzapfel BM, Pilge H, Prodinger PM, Toepfer A, Mayer-Wagner S, Hutmacher DW et al (2014) Customised osteotomy guides and endoprosthetic reconstruction for periacetabular tumours. Int Orthop 38:1435–1442PubMedPubMedCentral
61.
Shaikh I, Aston W, Hellawell G, Ross D, Littler S, Burling D et al (2015) Extended lateral pelvic sidewall excision (ELSiE): an approach to optimize complete resection rates in locally advanced or recurrent anorectal cancer involving the pelvic sidewall. Tech Coloproctology 19:119–120CrossRef
62.
63.
Bankar S, Desouza A, Paliwal V, Pandey D, Gori J, Sukumar V et al (2020) Novel use of the Bakri balloon to minimize empty pelvis syndrome following laparoscopic total pelvic exenteration. Colorectal Dis 22:2322–2325PubMedCrossRef
64.
Kazuma SME, Kazi M, Sukumar V, Saklani A (2021) Review of postoperative perineal hernia and available reconstruction techniques. Surg Case Rep. Science Repository OU 2021: 1–4
65.
Melich G, Lim DR, Hur H, Min BS, Baik SH, Arena GO et al (2016) Prevention of perineal hernia after laparoscopic and robotic abdominoperineal resection: review with illustrative case series of internal hernia through pelvic mesh. Can J Surg J Can Chir 59:54–58CrossRef
66.
Kobayashi A, Sugito M, Ito M, Saito N (2007) Predictors of successful salvage surgery for local pelvic recurrence of rectosigmoid colon and rectal cancers. Surg Today 37:853–859PubMedCrossRef
67.
Bahadoer RR, Dijkstra EA, van Etten B, Marijnen CAM, Putter H, Kranenbarg EM-K et al (2021) Short-course radiotherapy followed by chemotherapy before total mesorectal excision (TME) versus preoperative chemoradiotherapy, TME, and optional adjuvant chemotherapy in locally advanced rectal cancer (RAPIDO): a randomised, open-label, phase 3 trial. Lancet Oncol 22:29–42PubMedCrossRef
68.
Ciseł B, Pietrzak L, Michalski W, Wyrwicz L, Rutkowski A, Kosakowska E et al (2019) Long-course preoperative chemoradiation versus 5 × 5 Gy and consolidation chemotherapy for clinical T4 and fixed clinical T3 rectal cancer: long-term results of the randomized Polish II study. Ann Oncol Off J Eur Soc Med Oncol 1(30):1298–1303CrossRef
69.
Conroy T, Lamfichekh N, Etienne P-L, Rio E, Francois E, Mesgouez-Nebout N, et al. (2020) Total neoadjuvant therapy with mFOLFIRINOX versus preoperative chemoradiation in patients with locally advanced rectal cancer: Final results of PRODIGE 23 phase III trial, a UNICANCER GI trial. J Clin Oncol. Wolters Kluwer; 38: 4007–4007
Metadata
Title
State-of-the-art surgery for recurrent and locally advanced rectal cancers
Authors
Mufaddal Kazi
Vivek Sukumar
Ashwin Desouza
Avanish Saklani
Publication date
01-09-2021
Publisher
Springer Berlin Heidelberg
Published in
Langenbeck's Archives of Surgery / Issue 6/2021
Print ISSN: 1435-2443
Electronic ISSN: 1435-2451
DOI
https://doi.org/10.1007/s00423-021-02285-8

Other articles of this Issue 6/2021

Langenbeck's Archives of Surgery 6/2021 Go to the issue

How-I-Do-It articles

Retrocolic retrogastric ROUX-EN-Y gastric bypass: how I do it

Original Article

Risk factors for anastomotic leakage after surgical resections for esophageal cancer

For Debate

Objective method for selective reconstruction of multiple graft arteries to potentially reduce biliary complications

Original Article

Performance of the American College of Surgeons National Surgical Quality Improvement calculator for early postoperative outcomes following bile duct repair hepaticojejunostomy

Original Article

The risk and predictors of mortality in octogenarians undergoing emergency laparotomy: a multicentre retrospective cohort study

Original Article

Evaluation of relationship between splenic artery and pancreatic parenchyma using three-dimensional computed tomography for laparoscopic distal pancreatectomy