eP606 - Total Pelvic Exenteration for Clinical T4b Colorectal Cancer: Clinical-Pathologic Factors Associated with Severe Perioperative Morbidity

ePoster Presenter(s)

• 

  Christopher W. Guske

  Medical Student
  University of South Florida Morsani College of Medicine
  Tampa, FL, United States

  All of the relevant financial relationships listed below have been mitigated.
  This individual has no financial relationships with ineligible companies.

Author(s)

• NI

  Nusheen Immen, n/a

  Undergraduate Researcher
  Moffitt Cancer Center
  Tampa, Florida, United States

  Disclosure information not submitted.
• DC

  Devon Conant, n/a

  Research Assistant
  Moffitt Cancer Center
  Tampa, Florida, United States

  Disclosure information not submitted.
• ES

  Erin Siegel, PhD, MPH

  Associate Member
  Moffitt Cancer Center
  Tampa, Florida, United States

  Disclosure information not submitted.
• 

  Julian Sanchez, MD (he/him/his)

  Senior Member, Department of Gastrointestinal Oncology
  Moffitt Cancer Center
  Moffitt Cancer Center
  Tampa, Florida, United States

  All relevant financial disclosures have been managed and will be listed below.
  This individual has no financial relationships with ineligible companies.
• AS

  Amalia Stefanou, MD FACS FASCRS

  Assistant Member
  Moffitt Cancer Center
  Tampa, Florida, United States

  Disclosure information not submitted.
• SD

  Sophie Dessureault, MD, PhD

  Senior Member
  Moffitt Cancer Center
  Tampa, Florida, United States

  Disclosure information not submitted.
• BM

  Brandon Manley, MD

  Physican
  Mofffitt Cancer Center
  Tampa, Florida, United States

  Disclosure information not submitted.

Senior Author(s)

• 

  Seth Felder, MD

  Associate Member, Department of Gastrointestinal Oncology
  Moffitt Cancer Center
  Moffitt Cancer Center
  Tampa, FL, United States

  All relevant financial disclosures have been managed and will be listed below.
  This individual has no financial relationships with ineligible companies.

Purpose/Background: Total pelvic exenteration (TPE) for clinically locally advanced pelvic T4b colorectal cancer (CRC) can be curative, however, is associated with significant morbidity, prolonged recovery, and impairment in quality of life. Pre-, intra-, and post-operative pathologic factors influencing 90-day perioperative complications are not well described, yet needed, to better counsel patients considering radical pelvic surgery.Methods/Interventions: A retrospective, single institutional series of primary and recurrent clinical T4b pelvic CRC undergoing TPE between 2017 and 2023 was identified. Preoperative treatment(s) including prior fecal/urinary diversion procedures, intraoperative metrics, and pathologic factors including surgical margin and histologic downstaging status were collected. 90-day complications were classified according to the Clavien-Dindo (CD) grade system (≥3, severe complication). Clinical and pathologic characteristics of patients experiencing a CD ≥3 complication were compared to patients with CD < 3 using conditional logistic regression for categorial variables and mixed-effect modeling for continuous variables. A multivariate regression analysis (MVA) was performed to identify significant predictors of a perioperative severe complication. Statistical significance was set at < 0.05.Results/Outcomes: 28 patients were included of which 24 were male (85.7%), median age was 58.5 (55.0-70.0) years, and 60.7% were classified as ASA 3 (Table 1). Pathologic T4b CRC was present in 20 (71.4%) patients (Table 1). All patients (100%) experienced at least one 90-day perioperative CD complication. 12 (42.9%) patients experienced a CD ≥3 90-day complication, including 11 (39%) patients with a CD 3 complication, and three (10.7%) with a CD 4 complication. No 90-day mortality was observed. Five (17.9%) patients required re-operation within 90-days. Median length of stay was 9 (7.0-12.0) days, and nine (32.1%) patients were re-admitted within 90-days. Preoperative hemoglobin on regression analysis reached statistical significance with an Odds Ratio of 4.6 (95% confidence interval [CI]: 1.4-31.9), p=0.04 for ≥CD 3 complication.Conclusion/

Discussion: Severe perioperative complications are common following TPE for clinical T4b CRC. In this single institutional series of locally advanced pelvic CRC’s undergoing TPE, only preoperative anemia was associated with severe CD ≥3 90-day perioperative complications. The expected complication risk and severity following TPE is high, such that the multi-specialty surgical team must provide a comprehensive informed consent discussing the range of gastrointestinal, urologic, and perineal surgical morbidity. Although the cohort is small and limited to identify predictive factors, it adds clinically applicable descriptive data to improve the surgeon-patient discussion.Table 1Baseline patient characteristics, preoperative lab values, and intraoperative data stratified by presence of at least one Clavien Dindo complication of 3 or greater.