Pelvic exenteration for colorectal and non-colorectal cancer: a comparison of perioperative and oncological outcome

Abstract

Background Pelvic exenteration (PE) is the only option for long-term cure of advanced cancer originating from different types of tumor or recurrent disease in the lower pelvis. The aim was to show differences between colorectal and non-colorectal cancer in survival and postoperative morbidity. Methods Retrospective data of 63 patients treated with total pelvic exenteration between 2013 and 2018 are reported. Pre-, intra-, and postoperative parameters, survival data, and risk factors for complications were analyzed. Results A total of 57.2% (n = 37) of the patients had colorectal cancer, 22.3% had gynecological malignancies (vulvar (n = 6) or cervical (n = 8) cancer), 11.1% (n = 7) had anal cancer, and 9.5% had other primary tumors. A total of 30.2% (n = 19) underwent PE for a primary tumor and 69.8% (n = 44) for recurrent cancer. The 30-day in-hospital mortality was 0%. Neoadjuvant treatment was administered to 65.1% (n = 41) of the patients and correlated significantly with postoperative complications (odds ratio 4.441; 95% CI: 1.375–14.342, P > 0.05). R0, R1, R2, and Rx resections were achieved in 65.1%, 19%, 1.6%, and 14.3% of the patients, respectively. In patients undergoing R0 resection, 2-year OS and RFS were 73.2% and 52.4%, respectively. Resection status was a significant risk factor for recurrence-free and overall survival (OS) in univariate analysis. Multivariate analysis revealed age (P = 0.021), ASA ≥ 3 (P = 0.005), high blood loss (P = 0.028), low preoperative hemoglobin level (P < 0.001), nodal positivity (P < 0.001), and surgical complications (P = 0.003) as independent risk factors for OS. Conclusion Pelvic exenteration is a procedure with high morbidity rates but remains the only curative option for advanced or recurrent colorectal and non-colorectal cancer in the pelvis.

A Systematic Review on Overall Survival and Disease-Free Survival Following Total Pelvic Exenteration

“…However, the risk of surgical complications in TPE has been reported to be 31.6-86%. Also, the surgical morbidity for cases of locally advanced cancer is 47.1%, which is 82% in cases of recurrent cancer (Lewandowska et al, 2020;Bogner et al, 2021). The most common postoperative complications after TPE surgery include hemorrhage 31.8%, ileus 25.8%, wound complications 21.3% and respiratory failure 16.1%.…”

“…One of the most common and significant causes of surgical complications is radiotherapy as neoadjuvant therapy. Although radiotherapy increases the chances of a negative resection margins, but it has no effect on survival for either colorectal or non-colorectal cancer (Bogner et al, 2021). PE has been a revolution in recent years, and according to the studies, the 5-year survival rate in these patients raised up to 60%.…”

Про Евісцерацію Тазу

“…Показання до евісцерацій тазу останні роки розширюють. Якщо вони можливі в об'ємі R0, то навіть виявлені поодинокі метастази в печінці та/чи легенях не можуть бути протипоказанням до таких втручань [8]. Окремі автори [21] розширюють показання до паліативних евісцерацій тазу.…”

“…Як у попередні, так і в останні роки наголошується [8] на необхідності централізації хворих із занедбаними пухлинами тазу в крупних лікувальних закладах, де є усі умови для надання високотехнологічної допомоги, щоб у таких хворих досягти статусу R0.…”

Opportunities and Limitations of Pelvic Exenteration Surgery

“…In addition to a curative and palliative intention, oncologists increasingly balance disease chronification with a good quality of life. This applies equally to the primary as well as to the recurrent disease [ 9 ]. An example of this is shown by Khoury-Collado et al and Lewis et al when analysing recurrent sarcomas and endometrial carcinomas [ 10 , 11 ].…”