Surgery
Two hundred and two (93.1%) patients underwent surgery with 131
(64.8%) complete resections, and 119 (90.8%) with upfront surgery.
Forty two (42/202; 20.7%) patients had incomplete resections, of whom
12 (28.6%) died: nine (75%) of disease progression, one from an
intra-operative aortic injury and two from other peri-operative
complications. Six patients (6/202; 2.9%) had irresectable tumours (two
with stage III disease; four with stage IV disease). Four of the six
died, three from disease and one from treatment related complications.
One patient had second look surgery with re-biopsy of tumour bed after
negative imaging at first re-assessment and is a survivor. Four patients
had no second look surgery and/or re-biopsy after negative imaging at
first evaluation: three relapsed of whom two died and one is presumed
dead/absconded.
Fifty seven patients (57/202; 28.7%) were operated following
neo-adjuvant chemotherapy. The timing varied between the first course
and sixth course of chemotherapy, subject to various factors that
included either a protocol provision or availability of surgeons or
available theatre time. One patient did not undergo definitive resection
due to the fact that no surgeon was available.
Nine patients experienced surgical complications. One suffered
post-operative urinary and faecal incontinence, three ovarian ‘failure’,
three delayed puberty, one rectal perforation with fistula formation and
one with adhesive bowel obstruction. Ten patients refused surgery, of
whom five are dead; all of whom had stage III disease at diagnosis.