Martyn Evans

Outcomes in locally advanced rectal cancer with highly selective preoperative chemoradiotherapy.

This study compared outcomes after surgery alone for stage II/ III rectal cancer in a tertiary cancer unit versus highly selective use of preoperative chemoradiotherapy (CRT).

Systematic review and meta-analysis of intraoperative peritoneal lavage for colorectal cancer staging

Intraperitoneal cancer cells are detectable at the time of colorectal cancer resection in some patients. The significance of this, particularly in patients with no other adverse prognostic features, is poorly defined. Consequently peritoneal lavage is not part of routine practice during colorectal cancer resection, in contrast with other abdominal malignancies. The aim of this systematic review was to determine the effect of positive intraoperative peritoneal cytology on cancer‐specific outcomes in colorectal cancer.

Oncological outcome after laparoscopic abdominoperineal excision of the rectum

Aim  Abdominoperineal excision of the rectum (APER) for cancer has been associated with higher circumferential resection margin (CRM) involvement and failure of local disease control. The aim of this study was to investigate whether the introduction of laparoscopic APER altered the incidence of CRM involvement.

Outcome of salvage surgery for anal squamous cell carcinoma

The purpose of this study was to examine factors related to treatment failure following chemoradiotherapy for squamous cancer and to compare the outcome of salvage surgery in one unit with national audit standards published by the Association of Coloproctology of Great Britain and Ireland (ACPGBI) (ACPGBI position statement for management of anal cancer. Colorectal Disease 2011; 13(Suppl. 1): 1–52).

Determinants of survival following pelvic exenteration for primary rectal cancer.

Pelvic exenteration is a potentially curative treatment for locally advanced primary rectal cancer. Previous studies have been limited by small sample sizes and heterogeneous data. A consecutive series of patients was studied to identify the clinicopathological determinants of survival.

Quality-of-life outcomes following pelvic exenteration for primary rectal cancer.

For patients with locally advanced tumours and contiguous organ involvement, pelvic exenteration (PE) can offer cure with relatively low mortality. The literature surrounding quality of life (QoL) in patients undergoing PE is limited. Furthermore, there are no matched comparisons of QoL between abdominoperineal resection (APR) and PE. The aim of this study was to compare differences in long‐term QoL for patients with primary rectal cancer undergoing APR versus PE.

Permanent stoma rates: a misleading marker of quality in rectal cancer surgery.

The latest National Bowel Cancer Audit Programme (NBOCAP) audit identified our colorectal unit as an outlier with regard to the high permanent stoma rate. The aim of this study was to perform an audit of the rationale for stoma formation in patients undergoing rectal cancer resection in our unit.

Rectal Cancer following Abdomino‐Perineal Pull‐Through for Imperforate Anus

A 40-year-old man presented with rectal ejaculation, pneumaturia, passive faecal incontinence and 13 kg weight loss. He had undergone a neorectal pull-through operation at the age of 10 months and there was no family history of colorectal cancer. He underwent an examination under anaesthetic (EUA) and endorectal ultrasound (ERUS; Fig. 1a). This demonstrated a clinically fixed anterior tumour, which on ERUS was a locally advanced (T4) neorectal tumour that had fistulated into the base of the urethra. Biopsies taken during EUA confirmed this to be an adenocarcinoma. Both local ERUS and magnetic resonance imaging (MRI) confirmed a bulky neorectal tumour and enlargement of local nodes. Computed tomography (CT) scan demonstrated no metastatic disease. The patient was managed with a defunctioning colostomy and long-course chemo-radiotherapy and planned total pelvic exenteration. Following neoadjuvant treatment he was restaged with repeated CT, CT positron emission tomography (PET), MRI and ERUS findings (Fig. 1b), which demonstrated no significant change in the local disease and no distant metastatic disease. The patient underwent a total pelvic clearance with urinary diversion by ileal conduit reconstruction. The perineal defect (Fig. 1c,d) was filled by a left inferior gluteal artery myocutaneous (IGAM) flap (Fig. 1c,f). He made a good post-operative recovery and was discharged on day 14. Subsequent histological examination demonstrated a ypT4 yN1 tumour and macroscopic malignant invasion of the urethra was confirmed. The circumferential resection margins were clear with the nearest margin at 4 mm. At 12 months follow-up he is well with no evidence of local or distant recurrence.

Pelvic exenteration for advanced malignancy in elderly patients.

Pelvic exenteration is an aggressive surgical procedure reserved for highly selected patients. Surgery in the elderly is often associated with increased morbidity and mortality. The aim of this study was to review outcomes following exenteration for advanced pelvic malignancy in this subgroup of patients.

Social deprivation in patients requiring pelvic exenterative surgery

Pelvic exenteration is an aggressive operation for locally advanced rectal cancer. Social deprivation has been shown to reduce life expectancy and has been linked to a poorer outcome in patients with colorectal cancer. The aim of this study was to analyse the effect of social deprivation scores on the outcome in these complex patients.