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.