Predictors of overall survival following extended radical resections for locally advanced and recurrent pelvic malignanc

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ORIGINAL ARTICLE

Predictors of overall survival following extended radical resections for locally advanced and recurrent pelvic malignancies Joseph C. Kong 1 & Oliver Peacock 1 & Peadar S. Waters 1 & Tim Eglinton 2 & Satish K. Warrier 1 & Christopher Wakeman 2 & Frank A. Frizelle 2 & Alexander G. Heriot 1 & Jacob J. McCormick 1 Received: 27 October 2019 / Accepted: 15 May 2020 # Springer-Verlag GmbH Germany, part of Springer Nature 2020

Abstract Purpose In an era of personalised medicine, there is an overwhelming effort for predicting patients who will benefit from extended radical resections for locally advanced pelvic malignancy. However, there is paucity of data on the effect of comorbidities and postoperative complications on long-term overall survival (OS). The aim of this study was to define predictors of 1year and 5-year OS. Methods Data were collected from prospective databases at two high-volume institutions specialising in beyond TME surgery for locally advanced and recurrent pelvic malignancies between 1990 and 2015. The primary outcome measures were 1-year and 5-year OS. Results A total of 646 consecutive extended radical resections were performed between 1990 and 2015. The majority were female patients (371, 57.4%) and the median age was 63 years (range 19–89 years). One-year OS, primary rectal adenocarcinoma had the best survival while recurrent colon cancer had the worse survival (p = 0.047). The 5-year OS between primary and recurrent cancers were 64.7% and 53%, respectively (p = 0.004). Poor independent prognostic markers for 5-year OS were increasing ASA score, cardiovascular disease, recurrent cancers, ovarian cancers, pulmonary embolus and acute respiratory distress syndrome. A positive survival benefit was demonstrated with preoperative radiotherapy (HR 0.55; 95% CI 0.4–0.75, p < 0.001). Conclusion Patient comorbidities and specific complications can influence long-term survival following extended radical resections. This study highlights important predictors, enabling clinicians to better inform patients of the potential short- and long-term outcomes in the management of locally advanced and recurrent pelvic malignancy. Keywords Pelvic malignancy . Radical resection . Recurrent cancer . Primary cancer

Introduction Pelvic exenteration was first described as an en bloc removal of the pelvic organs for advanced or recurrent cancers [1]. Previously, such a radical approach has a significant Joseph C. Kong and Oliver Peacock are co-first authors. * Peadar S. Waters [email protected] Jacob J. McCormick [email protected] 1

Division of Cancer Surgery, Peter MacCallum Cancer Centre, 305 Grattan Street, Melbourne, VIC 3000, Australia

2

Colorectal Surgery Unit, Christchurch Hospital, Christchurch, New Zealand

postoperative consequence, with reported 30-day mortality rate of 17.2%, 2-year overall survival (OS) of 27% and 5year OS of 17% [2]. Subsequently, through improvements in perioperative care and surgical technique, current accepted mortality rates are 1.1–2% and 5-year OS of 40–