دورية أكاديمية
أعرض في EDS

Impact of Intraoperative Decision-Making on Pathological Margin Status in Patients Undergoing Pelvic Exenteration for Locally Recurrent Rectal Cancer.

التفاصيل البيبلوغرافية
العنوان: Impact of Intraoperative Decision-Making on Pathological Margin Status in Patients Undergoing Pelvic Exenteration for Locally Recurrent Rectal Cancer.
المؤلفون: Ebrahimi N; Department of Colorectal Surgery, Royal Prince Alfred Hospital, Sydney, Australia.; Surgical Outcomes Research Centre (SOuRCe), Royal Prince Alfred Hospital, Sydney, Australia., Brown KGM; Department of Colorectal Surgery, Royal Prince Alfred Hospital, Sydney, Australia.; Surgical Outcomes Research Centre (SOuRCe), Royal Prince Alfred Hospital, Sydney, Australia.; Institute of Academic Surgery (IAS), Royal Prince Alfred Hospital, Sydney, Australia.; Faculty of Medicine and Health, Central Clinical School, The University of Sydney, New South Wales, Australia., Ng KS; Department of Colorectal Surgery, Royal Prince Alfred Hospital, Sydney, Australia.; Surgical Outcomes Research Centre (SOuRCe), Royal Prince Alfred Hospital, Sydney, Australia.; Institute of Academic Surgery (IAS), Royal Prince Alfred Hospital, Sydney, Australia.; Faculty of Medicine and Health, Central Clinical School, The University of Sydney, New South Wales, Australia.; Department of Colorectal Surgery, Concord Repatriation General Hospital, Sydney, Australia., Solomon MJ; Department of Colorectal Surgery, Royal Prince Alfred Hospital, Sydney, Australia.; Surgical Outcomes Research Centre (SOuRCe), Royal Prince Alfred Hospital, Sydney, Australia.; Institute of Academic Surgery (IAS), Royal Prince Alfred Hospital, Sydney, Australia.; Faculty of Medicine and Health, Central Clinical School, The University of Sydney, New South Wales, Australia., Lee PJ; Department of Colorectal Surgery, Royal Prince Alfred Hospital, Sydney, Australia.; Surgical Outcomes Research Centre (SOuRCe), Royal Prince Alfred Hospital, Sydney, Australia.; Institute of Academic Surgery (IAS), Royal Prince Alfred Hospital, Sydney, Australia.
المصدر: Diseases of the colon and rectum [Dis Colon Rectum] 2024 Aug 01; Vol. 67 (8), pp. 1024-1029. Date of Electronic Publication: 2024 Feb 21.
نوع المنشور: Journal Article; Observational Study; Video-Audio Media
اللغة: English
بيانات الدورية: Publisher: Lippincott Country of Publication: United States NLM ID: 0372764 Publication Model: Print-Electronic Cited Medium: Internet ISSN: 1530-0358 (Electronic) Linking ISSN: 00123706 NLM ISO Abbreviation: Dis Colon Rectum Subsets: MEDLINE
أسماء مطبوعة: Original Publication: Philadelphia. Lippincott
مواضيع طبية MeSH: Pelvic Exenteration*/methods , Rectal Neoplasms*/surgery , Rectal Neoplasms*/pathology , Neoplasm Recurrence, Local*/epidemiology , Margins of Excision*, Humans ; Female ; Retrospective Studies ; Male ; Middle Aged ; Aged ; Clinical Decision-Making ; Adult
مستخلص: Background: A key component of preoperative preparation for pelvic exenteration surgery is the development of an operative plan in a multidisciplinary setting based on the extent of local tumor invasion on preoperative imaging. Changes to the extent of resection or operative plan may occur intraoperatively based on intraoperative findings.
Objective: To report the frequency and extent of intraoperative deviation from the planned extent of resection during pelvic exenteration for locally recurrent rectal cancer and determine whether this resulted in a more or less radical resection.
Design: Retrospective observational study.
Settings: A high-volume pelvic exenteration center.
Patients: Patients who underwent pelvic exenteration for locally recurrent rectal cancer between January 2015 and December 2020.
Main Outcome Measures: Frequency and extent of intraoperative deviation from the planned extent of resection, R0 resection rate.
Results: One hundred thirty-six patients underwent pelvic exenteration for locally recurrent rectal cancer, of whom 110 (81%) had R0 resection margins. Twelve patients were excluded because of missing information, and 49 patients (40%) had a change to the operative plan. Operative changes were major in 30 patients (61%), more radical in 40 patients (82%), and margin relevant in 24 patients (49%). In patients in whom there was a change to the operative plan and R0 resection was achieved, the median distance to a relevant margin was 2.5 mm (range, 0.1-10 mm). Of 8 patients with a change in operative plan and R1 resection, 3 were margin relevant, of whom all were considered major, and 2 were more radical and 1 was less radical.
Limitations: Generalizability outside of specialist units may be limited.
Conclusions: Intraoperative changes to the planned extent of resection occur commonly and most often result in an unanticipated major or more radical resection. Such changes may contribute to high rates of R0 resection margins in specialist pelvic exenteration units that use an ultraradical approach in these patients. See Video Abstract .
Impacto De La Toma De Decisiones Intraoperatoria Sobre El Estado Del Margen Patolgico En Pacientes Sometidos a Exenteracin Plvica Por Recurrencia Local En Cncer De Recto: ANTECEDENTES:Un componente clave de la preparación preoperatoria para exenteración pélvica es el desarrollo de un plan quirúrgico en un entorno multidisciplinario, basado en el grado de invasión tumoral local en las imágenes preoperatorias. Es posible que se produzcan cambios intraoperatorios en la extensión de la resección o en el plan quirúrgico según los hallazgos intraoperatorios.OBJETIVO:Informar la frecuencia y la extensión de la desviación intraoperatoria de la extensión planificada de la resección durante la exenteración pélvica para el cáncer de recto localmente recurrente, y si esto resultó en una resección más o menos radical.DISEÑO:Estudio observacional retrospectivo.ESCENARIO:Un centro de exenteración pélvica de alto volumen.PACIENTES:Pacientes sometidos a exenteración pélvica por cáncer de recto localmente recurrente entre enero de 2015 y diciembre de 2020.PRINCIPALES MEDIDAS DE RESULTADO:Frecuencia y extensión de desviación intraoperatoria de la extensión planeada de resección, tasa de resección R0.RESULTADOS:136 pacientes fueron sometidos a exenteración pélvica por cáncer de recto localmente recurrente, de los cuales 110 (81%) tuvieron márgenes de resección R0. 12 pacientes fueron excluidos por falta de información y 49 pacientes (40%) tuvieron un cambio en el plan quirúrgico. Los cambios operatorios fueron mayores en 30 pacientes (61%), más radicales en 40 pacientes (82%) y con relevancia sobre márgenes en 24 pacientes (49%). En los pacientes en los que hubo un cambio en el plan quirúrgico y se logró la resección R0, la distancia mediana hasta un margen relevante fue de 2.5 mm (rango 0.1-10 mm). De ocho pacientes con un cambio en el plan quirúrgico y resección R1, tres tuvieron relevancia sobre márgenes de los cuales todos se consideraron mayores, dos fueron más radicales y uno fue menos radical.LIMITACIONES:La generalización fuera de las unidades especializadas puede ser limitada.CONCLUSIONES:Los cambios intraoperatorios en la extensión planificada de la resección ocurren comúnmente y con mayor frecuencia resultan en una resección mayor imprevista y más radical. Dichos cambios pueden contribuir a altas tasas de márgenes de resección R0 en unidades especializadas en EP que emplean un enfoque ultrarradical en estos pacientes. (Traducción-Dr. Jorge Silva Velazco ).
(Copyright © The ASCRS 2024.)
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تواريخ الأحداث: Date Created: 20240221 Date Completed: 20240717 Latest Revision: 20240717
رمز التحديث: 20240718
DOI: 10.1097/DCR.0000000000003131
PMID: 38380808
قاعدة البيانات: MEDLINE
الوصف
تدمد:1530-0358
DOI:10.1097/DCR.0000000000003131