Pelvic exenteration for advanced and recurrent malignancy

Abstract

Background: Improved surgical techniques and oncological treatment render many advanced pelvic tumors amenable to curative resection. We evaluated morbidity, survival, and quality of life (QoL) after extended pelvic procedures.

Methods: From January 2003 to November 2008, 85 patients underwent multivisceral pelvic resection; 87% had colorectal or anal malignancies. Preoperatively, endoscopy and imaging procedures were performed, followed by multidisciplinary assessment. Fifty-eight percent received preoperative chemotherapy and pelvic irradiation. Exenteration was total in 32 patients and posterior in 48. Five posterior resections included partial cystectomy and 21 encompassed resection of the bony pelvis. Myocutaneous flaps were used for reconstruction in 33 cases. Urinary diversion was achieved by ileal conduit in 24 and by continent pouch in 8. QoL was evaluated prospectively in 22 late cases.

Results: All patients were evaluated. Clear margins were obtained in 66%. Median duration of surgery was 680 (310-1,320) min, and blood loss was 1,800 (350-19,000) ml. Morbidity was 68%, whereof major complications constituted 13%. Median hospital stay was 18 (5-70) days. There was no 90-day mortality. Median follow-up was 24 (3-71) months. Local control was obtained in 77 patients. Twenty-seven manifested disseminated disease without local recurrence, two developed isolated local recurrence, and six had local and systemic recurrences. Twenty-one died after a median of 11 (4-55) months follow-up. Survival was correlated with clear margins and time to relapse. QoL was improved at 16 months after surgery.

Conclusions: Multivisceral pelvic surgery is possible with acceptable morbidity and QoL. Thorough patient selection and multimodal therapy are necessary to attain maximum benefit.