gms | German Medical Science

Background: Pelvic exenteration is an extensive surgical procedure with significant morbidity and mortality. The aim of this study was to report outcomes after resection and identify factors that predict long-term survival in patients with pelvic malignancies.

Materials and methods: Consecutive patients that underwent pelvic exenteration between January 2002 und December 2013 were identified from the author’s prospectively maintained database. Patient demographics, perioperative and oncological outcomes were analyzed.

Results: Overall, 131 patients underwent pelvic exenteration (colorectal cancer, n=69; anal cancer, n=7; gynecological cancer, n=27; sarcoma, n=12; other cancer, n=13; benign indications, n =3). Overall minor and major complications rates were 32.1% and 53.4% respectively. Within the malignant indications, 39.8% were primary advanced tumors and 60.2% were recurrent cancers. R-0, R-1, and R-2 resections were achieved in 57.8%, 38.3% and 3.9% respectively. The R-0 rate in patients following PE for primary and recurrent cancers were similar (58.3% vs. 61.3%, p=0.4). After R-1 resection 5-year DFS and OS was significantly reduced (R-0 vs. R-1; DFS, 32.4% vs. 18.4%, p=0.02; OS, 41.9% vs. 32.7%, p=0.02). Primary or recurrent disease stage and cancer type did not impact this observation. Overall 30-day mortality was 2.4%.

Conclusion: Pelvic exenteration is accompanied with considerable morbidity. However, regardless of the entity of the disease and whether it is a primary or recurrent disease, long-term survival is achievable if an R-0 resection is performed.