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Thorgersen EB, Solbakken AM, Strøm TK, Goscinski M, Spasojevic M, Larsen SG, Flatmark K. Short-term results after robot-assisted surgery for primary rectal cancers requiring beyond total mesorectal excision in multiple compartments. Scand J Surg 2024; 113:3-12. [PMID: 37787437 DOI: 10.1177/14574969231200654] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/04/2023]
Abstract
AIM Rectal cancers requiring beyond total mesorectal excision (bTME) are traditionally operated using an open approach, but the use of minimally invasive robot-assisted procedures is increasing. Introduction of minimal invasive surgery for complex cancer cases could be associated with compromised surgical margins or increased complication rates. Therefore, reporting results both clinical and oncological in large series is important. Since bTME procedure reports are heterogeneous, comparing results is often difficult. In this study, a magnetic resonance imaging (MRI) classification system was used to describe the bTME surgery according to pelvic compartments. METHODS Consecutive patients with primary rectal cancer operated with laparoscopic robot-assisted bTME were prospectively included for 2 years. All patients had tumors that threatened the mesorectal fascia, invaded adjacent organs, and/or involved metastatic pelvic lateral lymph nodes. Short-term clinical outcomes and oncological specimen quality were registered. Surgery was classified according to pelvic compartments resected. RESULTS Clear resection margins (R0 resection) were achieved in 95 out of 105 patients (90.5%). About 26% had Accordion Severity Grading System of Surgical Complications grade 3-4 complications and 15% required re-operations. About 7% were converted to open surgery. The number of compartments resected ranged from one to the maximum seven, with 83% having two or three compartments resected. All 10 R1 resections occurred in the lateral and posterior compartments. CONCLUSIONS The short-term clinical outcomes and oncological specimen quality after robot-assisted bTME surgery were comparable to previously published open bTME surgery. The description of surgical procedures using the Royal Marsden MRI compartment classification was feasible.
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Affiliation(s)
- Ebbe B Thorgersen
- Department of Gastroenterological Surgery Oslo University Hospital The Radium Hospital Pb 4950 Nydalen 0424 Oslo Norway
| | - Arne M Solbakken
- Department of Gastroenterological Surgery, Oslo University Hospital, The Radium Hospital, Oslo, Norway
- Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, Oslo, Norway
- Department of Tumor Biology, Oslo University Hospital, The Radium Hospital, Oslo, Norway
| | - Tuva K Strøm
- Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, Oslo, Norway
| | - Mariusz Goscinski
- Department of Gastroenterological Surgery, Oslo University Hospital, The Radium Hospital, Oslo, Norway
| | - Milan Spasojevic
- Department of Gastroenterological Surgery, Oslo University Hospital, The Radium Hospital, Oslo, Norway
| | - Stein G Larsen
- Department of Gastroenterological Surgery, Oslo University Hospital, The Radium Hospital, Oslo, Norway
| | - Kjersti Flatmark
- Department of Gastroenterological Surgery, Oslo University Hospital, The Radium Hospital, Oslo, Norway
- Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, Oslo, Norway
- Department of Tumor Biology, Oslo University Hospital, The Radium Hospital, Oslo, Norway
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Brown K, Solomon M, Ng KS, Sutton P, Koh C, White K, Steffens D. Development of a risk prediction tool for patients with locally advanced and recurrent rectal cancer undergoing pelvic exenteration: protocol for a mixed-methods study. BMJ Open 2023; 13:e075304. [PMID: 37648387 PMCID: PMC10471871 DOI: 10.1136/bmjopen-2023-075304] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/04/2023] [Accepted: 08/18/2023] [Indexed: 09/01/2023] Open
Abstract
INTRODUCTION Pelvic exenteration (PE) surgery represents the only potentially curative treatment option for patients with locally advanced or recurrent rectal cancer (LARRC). Given the potential morbidity, whether or not PE should be recommended for an individual patient presents a major decisional conflict. This study aims to identify the outcomes of PE for which there is consensus among patients, carers and clinicians regarding their importance in guiding treatment decision-making, and to develop a risk prediction tool which predicts these outcomes. METHODS AND ANALYSIS This study will be conducted at a specialist PE centre, and employ a mixed-methods study design, divided into three distinct phases. In phase 1, outcomes of PE will be identified through a comprehensive systematic review of the literature (phase 1a), followed by exploration of the experiences of individuals who have undergone PE for LARRC and their carers (phase 1b, target sample size 10-20 patients and 5-10 carers). In phase 2, a survey of patients, their carers and clinicians will be conducted using Delphi methodology to explore consensus around the outcomes of highest priority and the level of influence each outcome should have on treatment decision-making. In phase 3 a, risk prediction tool will be developed using data from a single PE referral centre (estimated sample size 500 patients) to predict priority outcomes using multivariate modelling, and externally validated using data from an international PE collaboration. ETHICS AND DISSEMINATION Ethical approval has been granted for phases 1 and 2 (X22-0422 and 2022/ETH02659) and for maintenance of the database used in phase 3 (X13-0283 and HREC/13/RPAH/504). Informed consent will be obtained from participants in phases 1b and 2; a waiver of consent for secondary use of data in phase 3 will be sought. Study results will be submitted for publication in international and/or national peer reviewed journals. PROSPERO REGISTRATION NUMBER CRD42022351909.
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Affiliation(s)
- Kilian Brown
- Department of Colorectal Surgery, Royal Prince Alfred Hospital, Sydney, New South Wales, Australia
- Surgical Outcomes Research Centre (SOuRCe), Royal Prince Alfred Hospital, Sydney, New South Wales, Australia
- Institute of Academic Surgery (IAS), Royal Prince Alfred Hospital, Sydney, New South Wales, Australia
- Faculty of Medicine and Health, Central Clinical School, The University of Sydney, Sydney, New South Wales, Australia
| | - Michael Solomon
- Department of Colorectal Surgery, Royal Prince Alfred Hospital, Sydney, New South Wales, Australia
- Surgical Outcomes Research Centre (SOuRCe), Royal Prince Alfred Hospital, Sydney, New South Wales, Australia
- Institute of Academic Surgery (IAS), Royal Prince Alfred Hospital, Sydney, New South Wales, Australia
- Faculty of Medicine and Health, Central Clinical School, The University of Sydney, Sydney, New South Wales, Australia
| | - Kheng-Seong Ng
- Department of Colorectal Surgery, Royal Prince Alfred Hospital, Sydney, New South Wales, Australia
- Surgical Outcomes Research Centre (SOuRCe), Royal Prince Alfred Hospital, Sydney, New South Wales, Australia
- Institute of Academic Surgery (IAS), Royal Prince Alfred Hospital, Sydney, New South Wales, Australia
- Faculty of Medicine and Health, Central Clinical School, The University of Sydney, Sydney, New South Wales, Australia
- Department of Colorectal Surgery, Concord Repatriation General Hospital, Sydney, New South Wales, Australia
| | - Paul Sutton
- Colorectal & Peritoneal Oncology Centre, The Christie NHS Foundation Trust, Manchester, UK
- Division of Cancer Sciences, The University of Manchester, Manchester, UK
| | - Cherry Koh
- Department of Colorectal Surgery, Royal Prince Alfred Hospital, Sydney, New South Wales, Australia
- Surgical Outcomes Research Centre (SOuRCe), Royal Prince Alfred Hospital, Sydney, New South Wales, Australia
- Institute of Academic Surgery (IAS), Royal Prince Alfred Hospital, Sydney, New South Wales, Australia
- Faculty of Medicine and Health, Central Clinical School, The University of Sydney, Sydney, New South Wales, Australia
| | - Kate White
- Sydney Nursing School, University of Sydney, Sydney, New South Wales, Australia
- The Daffodil Centre, University of Sydney and Cancer Council NSW, Sydney, New South Wales, Australia
| | - Daniel Steffens
- Surgical Outcomes Research Centre (SOuRCe), Royal Prince Alfred Hospital, Sydney, New South Wales, Australia
- Faculty of Medicine and Health, Central Clinical School, The University of Sydney, Sydney, New South Wales, Australia
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Carvalho F, Qiu S, Panagi V, Hardy K, Tutcher H, Machado M, Silva F, Dinen C, Lane C, Jonroy A, Knox J, Worley L, Whibley J, Perren T, Thain J, McPhail J. Total Pelvic Exenteration surgery - Considerations for healthcare professionals. EUROPEAN JOURNAL OF SURGICAL ONCOLOGY 2023; 49:225-236. [PMID: 36030135 DOI: 10.1016/j.ejso.2022.08.011] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2022] [Revised: 07/22/2022] [Accepted: 08/12/2022] [Indexed: 01/24/2023]
Abstract
BACKGROUND Associated with considerable risk of morbidity, Total Pelvic Exenteration (TPE) is a life-altering procedure involving a significant prolonged recovery. As a result, and with the view of achieving the best outcomes and lessen short and long-term morbidities, a well-thought-out and coordinated multidisciplinary team approach, is crucial to the provision of safe and high-quality care. METHOD Using a nominal group technique and qualitative methodology, this article explores the current practices in the care of oncology patients who undergo TPE surgery, in a tertiary cancer centre, by highlighting considerations of a collaboratively multi-disciplinary team. RESULTS This article provides guidance on the multi-disciplinary team approach, relating to TPE surgery, with discussion of clinical concerns, and with the goal of high patient satisfaction, provision of effective care and the lessening of short and long-term morbidities. CONCLUSION Oncology patients that undergo TPE surgery benefit from the contribution of a diversified multidisciplinary team as skilled and competent care that meets patient's health and social care needs is provided in a holistic, comprehensive, and timely care manner. Improving patient's care, pathway and postoperative outcomes, with the use of clinical expertise and support from professionals in the multidisciplinary team, can maximise care.
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Affiliation(s)
- Filipe Carvalho
- The Royal Marsden Hospital NHS Foundation Trust, London, UK.
| | - Shengyang Qiu
- The Royal Marsden Hospital NHS Foundation Trust, London, UK
| | - Vasia Panagi
- The Royal Marsden Hospital NHS Foundation Trust, London, UK
| | - Katy Hardy
- The Royal Marsden Hospital NHS Foundation Trust, London, UK
| | - Hannah Tutcher
- The Royal Marsden Hospital NHS Foundation Trust, London, UK
| | - Marta Machado
- The Royal Marsden Hospital NHS Foundation Trust, London, UK
| | | | - Caroline Dinen
- The Royal Marsden Hospital NHS Foundation Trust, London, UK
| | - Carol Lane
- The Royal Marsden Hospital NHS Foundation Trust, London, UK
| | - Alleh Jonroy
- The Royal Marsden Hospital NHS Foundation Trust, London, UK
| | - Jon Knox
- The Royal Marsden Hospital NHS Foundation Trust, London, UK
| | - Lynn Worley
- The Royal Marsden Hospital NHS Foundation Trust, London, UK
| | | | - Tobias Perren
- The Royal Marsden Hospital NHS Foundation Trust, London, UK
| | - Jane Thain
- The Royal Marsden Hospital NHS Foundation Trust, London, UK
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Makker PGS, Koh CE, Ansari N, Gonzaga N, Bartyn J, Solomon M, Steffens D. Functional Outcomes Following Cytoreductive Surgery and Hyperthermic Intraperitoneal Chemotherapy: A Prospective Cohort Study. Ann Surg Oncol 2023; 30:447-458. [PMID: 36305987 PMCID: PMC9726807 DOI: 10.1245/s10434-022-12691-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2022] [Accepted: 10/06/2022] [Indexed: 12/14/2022]
Abstract
BACKGROUND Pre-operative physical status and its association with post-operative surgical outcomes is poorly understood in patients with peritoneal malignancy who undergo cytoreductive surgery (CRS) with hyperthermic intraperitoneal chemotherapy (HIPEC). The aims of this study were to determine the pre-operative physical function in patients having CRS-HIPEC and investigate the association between physical function and post-operative outcomes. PATIENTS AND METHODS Patients undergoing CRS-HIPEC between 2017 and 2021 were recruited at a single quaternary referral hospital in Sydney, Australia. The primary physical function measures were the 6-min walk test (6MWT) and the five-times sit to stand test (5STS). Data were collected pre-operatively and at post-operative day 10, and were analysed according to pre-operative patient characteristics and post-operative outcomes such as length of hospital stay (LOS) and complications. RESULTS The cohort of patients that participated in functional assessments consisted of 234 patients, with a median age of 56 years. Patients having CRS-HIPEC performed worse on the 6MWT pre-operatively compared with the general Australian population (p < 0.001). Post-operatively, these patients experienced a further deterioration in 6MWT and 5STS performance and the degree of the post-operative decline in function was associated with post-operative morbidity. A higher level of pre-operative physical function was associated with shorter LOS and minor post-operative complications. CONCLUSIONS Patients who have undergone CRS-HIPEC were functionally impaired pre-operatively compared with the general population and experience a further deterioration of physical function post-operatively. A higher level of pre-operative physical function is associated with minor post-operative morbidity, which is highly relevant for pre-operative optimisation of patients with cancer.
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Affiliation(s)
- Preet G. S. Makker
- Surgical Outcomes Research Centre (SOuRCe), Royal Prince Alfred Hospital, Sydney, NSW Australia
| | - Cherry E. Koh
- Surgical Outcomes Research Centre (SOuRCe), Royal Prince Alfred Hospital, Sydney, NSW Australia ,Faculty of Medicine and Health, Central Clinical School, The University of Sydney, Sydney, NSW Australia ,Department of Colorectal Surgery, Royal Prince Alfred Hospital, Sydney, NSW Australia ,RPA Institute of Academic Surgery, Royal Prince Alfred Hospital, Sydney, NSW Australia
| | - Nabila Ansari
- Surgical Outcomes Research Centre (SOuRCe), Royal Prince Alfred Hospital, Sydney, NSW Australia ,Faculty of Medicine and Health, Central Clinical School, The University of Sydney, Sydney, NSW Australia ,Department of Colorectal Surgery, Royal Prince Alfred Hospital, Sydney, NSW Australia ,RPA Institute of Academic Surgery, Royal Prince Alfred Hospital, Sydney, NSW Australia
| | - Nicole Gonzaga
- Surgical Outcomes Research Centre (SOuRCe), Royal Prince Alfred Hospital, Sydney, NSW Australia
| | - Jenna Bartyn
- Surgical Outcomes Research Centre (SOuRCe), Royal Prince Alfred Hospital, Sydney, NSW Australia
| | - Michael Solomon
- Surgical Outcomes Research Centre (SOuRCe), Royal Prince Alfred Hospital, Sydney, NSW Australia ,Faculty of Medicine and Health, Central Clinical School, The University of Sydney, Sydney, NSW Australia ,Department of Colorectal Surgery, Royal Prince Alfred Hospital, Sydney, NSW Australia ,RPA Institute of Academic Surgery, Royal Prince Alfred Hospital, Sydney, NSW Australia
| | - Daniel Steffens
- Surgical Outcomes Research Centre (SOuRCe), Royal Prince Alfred Hospital, Sydney, NSW Australia ,Faculty of Medicine and Health, Central Clinical School, The University of Sydney, Sydney, NSW Australia
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Makker PGS, Koh C, Steffens D. ASO Author Reflections: Pre-operative Function Status Predicts Post-operative Outcomes in Patients Undergoing Cytoreductive Surgery and Hyperthermic Intra-peritoneal Chemotherapy. Ann Surg Oncol 2023; 30:459-460. [PMID: 36305991 DOI: 10.1245/s10434-022-12750-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2022] [Accepted: 10/17/2022] [Indexed: 12/13/2022]
Affiliation(s)
- Preet G S Makker
- Surgical Outcomes Research Centre (SOuRCe), Royal Prince Alfred Hospital, Sydney, NSW, Australia. .,Colorectal Department, Royal Prince Alfred Hospital, Sydney, NSW, Australia.
| | - Cherry Koh
- Surgical Outcomes Research Centre (SOuRCe), Royal Prince Alfred Hospital, Sydney, NSW, Australia.,Colorectal Department, Royal Prince Alfred Hospital, Sydney, NSW, Australia.,Faculty of Medicine and Health, Central Clinical School, The University of Sydney, New South Wales, Australia
| | - Daniel Steffens
- Surgical Outcomes Research Centre (SOuRCe), Royal Prince Alfred Hospital, Sydney, NSW, Australia.,Faculty of Medicine and Health, Central Clinical School, The University of Sydney, New South Wales, Australia
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