Radical surgical treatement in pelvic advanced cancer

Abstract

Total pelvic exenteration (TPE) is a radical and aggressive procedure performed in the local advanced pelvic cancer started from any pelvic organ. The experience of 213 TPE performed for local invasive cancer and centro-pelvic recurrences with initial malignancy at the cervix (125 cases), rectum (48 cases), vagina (11 cases), endometer (11 cases), ovary (9 cases), urinary bladder (3 cases), vulva (2 cases), retroperitoneum (2 cases), prostate (1 case) and myometrium (1 case), in 173 females and 40 males with age range 21-78 years, are analysed. The procedures were performed for advanced pelvic cancer in 71 cases (33.34%) and also for invasive centro-pelvic recurrences in 142 cases (66.66%). In 78 cases, TPE was extended laterally. 24 were composite resections. In 125 patients reconstructive procedures were added. All patients survived to surgery but 17 postoperative deaths (7.98%) were recorded. Complications occurred in 45.53% of cases, 97 from 213 patients had one or more than one complication with an average of 1.5 per patient. 52 among these patients (24.41%) requiring operative treatment. The average survival was 49.07 months, the median survival of 55 months and the estimated survival at 11 and 78 months was 66%, respectively 50%. The procedure is indicated in the absence of pelvic wall invasion and secondary distant dissemination and lengthens significantly the life span and increase the quality of life.