Pelvic exenteration: a review of current issues/controversies.

Management of advanced or recurrent pelvic cancer has evolved dramatically over the past few decades. Patients who were previously considered inoperable are now candidates for potentially curative surgery and avoid suffering with intractable symptoms. Up to 10% of primary rectal cancers present with isolated advanced local disease and between 10% and 15% of patients develop localized recurrence following proctectomy. Advances in surgical technique, reconstruction and multidisciplinary involvement have led to a reduction in mortality and morbidity and culminated in higher R0 resection rates with superior longer-term survival outcomes. Recent studies boast over 50% 5-year survival for rectal with an R0 resection. Exenteration has cemented itself as an important treatment option for advanced primary/recurrent pelvic tumours, however, there are still a few controversies. This review will discuss some of these issues, including: limitations of resection and the approach to high/wide tumours; the role of acute exenteration; re-exenteration; exenteration in the setting of metastatic disease and palliation; the role of radiotherapy (including intra-operative and re-irradiation); management of the empty pelvis; and the impact on quality of life and function.

Appendicitis presenting as the first manifestation of colorectal carcinoma: a 13-year retrospective study.

AIM: Appendicitis in older adults may present as the first sign of underlying colorectal cancer. We aim to determine whether there was a difference in the rate of diagnosis of colorectal carcinoma for patients ≥45 years following a presentation with appendicitis, compared with New Zealand standardised rates. METHOD: Retrospective study of patients ≥45 years with a confirmed diagnosis of appendicitis from 2003 to 2015 inclusive. The rate of colorectal carcinoma diagnosed during the 36-month follow-up period was calculated and compared to standardised rates, as per the New Zealand cancer registry. RESULTS: Six hundred and twenty-nine patients were included for analysis, 15 had a diagnosis of colorectal cancer in the follow-up period. Patients ≥45 years had a 6.3-fold (CI 3.6-10.2) increased risk of colorectal carcinoma than predicted given the population demographics. Those patients aged between 45-60 years had a 17-fold (95% CI 8-32.2) increased standardised risk ratio. CONCLUSION: This is the first study of its kind conducted in Australasia. This study found patients ≥45 years who present with appendicitis have significantly increased risk of underlying colorectal cancer. Until further research is conducted the authors recommend clinicians consider colonic investigation for older adults following a diagnosis of appendicitis.