Pelvic exenteration with en bloc iliac vessel resection for lateral pelvic wall involvement

Abstract

Purpose: Lateral pelvic recurrence is considered a poor prognostic variable and a relative contraindication to surgery because of the difficulty in achieving clear margins. The aim of this study was to outline our surgical approach to lateral pelvic sidewall involvement and assess the oncologic and long-term outcomes.

Methods: A retrospective review of a prospective database was performed. Patient demographics, cancer and operative details, intent, margins, lymph node status, rerecurrence at resection site, follow-up, living and death details were assessed.

Results: En bloc lateral pelvic wall dissection and vascular resection with pelvic exenteration was performed in 36 patients of 107 exenterations. All patients underwent surgery with curative intent. Negative margins were achieved in 19 patients (53%). Ten patients (28%) developed recurrence at the site of resection compared with 26 patients (72%) who remained disease free at the site of surgery. Sixteen patients (46%) are disease-free with the average disease-free interval of 30 months. Twenty-five patients (69%) are alive with a mean follow-up of 19 months. No mortalities occurred in this cohort of patients.

Conclusion: Despite the complexity of this technique, it is safe and feasible. Careful preoperative radiologic assessment and a multidisciplinary approach are paramount to achieving clear margins.