Pelvic exenteration with en bloc resection of the pelvic sidewall and intraoperative electron beam radiotherapy with Mobetron® for locally advanced rectal cancer
Pelvic exenteration with en bloc resection of the pelvic sidewall and intraoperative electron beam radiotherapy with Mobetron® for locally advanced rectal cancer
Locally advanced rectal cancer (LARC) is defined as a tumour which is predicted by magnetic resonance imaging to require an extended surgical resection beyond the total mesorectal excision plane. Preoperative neoadjuvant treatments are commonly utilised to downstage and downsize the tumour, facilitating resection. In patients with persistent predicted involved margins or poor response to neoadjuvant treatment, several studies and a meta-analysis have shown that intraoperative electron beam radiotherapy (IOERT) is a further useful adjunct to extended margin surgery, leading to low recurrence within the IOERT field even in patients with a positive margin. Here we describe a case of LARC with anterior and pelvic sidewall involvement and predicted stage of T4N0M0 with involved circumferential resection margins. A poor radiological response to neoadjuvant therapy was noted, and the patient was subsequently treated with a posterior pelvic exenteration with en bloc pelvic sidewall resection and IOERT using the IntraOp®Mobetron® device (IntraOp, Sunnyvale, CA, USA). Final histology was ypT4N0 EMVI-negative R1 (pelvic sidewall margin, 0.3 mm) TRG4 (minimal response to neoadjuvant therapy). Post-operative recovery was complicated by a temporary ileus requiring parenteral nutrition. At 6-week and 3-month reviews, the patient had returned to preoperative functional status.
493-495
Rangarajan, Karan
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Bhome, Rahul
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Bateman, N.
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Naga, A.
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Simon, M.
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Donovan, K.
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Smith, Julian
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Mirnezami, Alexander
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21 June 2017
Rangarajan, Karan
564d1804-d037-4f5a-ba46-580deea13e6c
Bhome, Rahul
d7b1e0d3-5925-460a-871d-5f52f69c649b
Bateman, N.
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Naga, A.
b12d8ef0-7602-404c-b219-1b31a89e4f84
Simon, M.
e4faadf3-74bb-4f7d-b406-ab05cb919600
Donovan, K.
676a975c-1d4b-44ce-9c7f-cd0e80fb5951
Smith, Julian
ab0ccf7a-4360-4148-8eaa-04a65fd9cb1a
Mirnezami, Alexander
b3c7aee7-46a4-404c-bfe3-f72388e0bc94
Rangarajan, Karan, Bhome, Rahul, Bateman, N., Naga, A., Simon, M., Donovan, K., Smith, Julian and Mirnezami, Alexander
(2017)
Pelvic exenteration with en bloc resection of the pelvic sidewall and intraoperative electron beam radiotherapy with Mobetron® for locally advanced rectal cancer.
Techniques in Coloproctology, 21 (6), .
(doi:10.1007/s10151-017-1649-1).
Abstract
Locally advanced rectal cancer (LARC) is defined as a tumour which is predicted by magnetic resonance imaging to require an extended surgical resection beyond the total mesorectal excision plane. Preoperative neoadjuvant treatments are commonly utilised to downstage and downsize the tumour, facilitating resection. In patients with persistent predicted involved margins or poor response to neoadjuvant treatment, several studies and a meta-analysis have shown that intraoperative electron beam radiotherapy (IOERT) is a further useful adjunct to extended margin surgery, leading to low recurrence within the IOERT field even in patients with a positive margin. Here we describe a case of LARC with anterior and pelvic sidewall involvement and predicted stage of T4N0M0 with involved circumferential resection margins. A poor radiological response to neoadjuvant therapy was noted, and the patient was subsequently treated with a posterior pelvic exenteration with en bloc pelvic sidewall resection and IOERT using the IntraOp®Mobetron® device (IntraOp, Sunnyvale, CA, USA). Final histology was ypT4N0 EMVI-negative R1 (pelvic sidewall margin, 0.3 mm) TRG4 (minimal response to neoadjuvant therapy). Post-operative recovery was complicated by a temporary ileus requiring parenteral nutrition. At 6-week and 3-month reviews, the patient had returned to preoperative functional status.
Text
10.1007_s10151-017-1649-1
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Accepted/In Press date: 1 June 2017
e-pub ahead of print date: 14 June 2017
Published date: 21 June 2017
Identifiers
Local EPrints ID: 415664
URI: http://eprints.soton.ac.uk/id/eprint/415664
ISSN: 1123-6337
PURE UUID: 6b6fa02e-4540-4d13-aecf-ec75856532d1
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Date deposited: 17 Nov 2017 17:30
Last modified: 16 Mar 2024 04:14
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Author:
Karan Rangarajan
Author:
N. Bateman
Author:
A. Naga
Author:
M. Simon
Author:
K. Donovan
Author:
Julian Smith
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