Total Pelvic Exenteration for Primary and Recurrent Malignancies

Abstract

Introduction Complete resection is the most important prognostic factor in surgery for pelvic tumors. In locally advanced and recurrent pelvic malignancies, radical margins are sometimes difficult to obtain because of close relation to or growth in adjacent organs/structures. Total pelvic exenteration (TPE) is an exenterative operation for these advanced tumors and involves en bloc resection of the rectum, bladder, and internal genital organs (prostate/ seminal vesicles or uterus, ovaries and/or vagina). Methods Between 1994 and 2008, a TPE was performed in 69 patients with pelvic cancer; 48 with rectal cancer (32 primary and 16 recurrent), 14 with cervical cancer (1 primary and 13 recurrent), 5 with sarcoma (3 primary and 2 recurrent), 1 with primary vaginal, and 1 with recurrent endometrial carcinoma. Ten patients were treated with neoadjuvant chemotherapy and 66 patients with preoperative radiotherapy to induce down-staging. Eighteen patients received IORT because of an incomplete or marginal complete resection.Results The median follow-up was 43 (range, 1-196) months. Median duration of surgery was 448 (range, 300-670) minutes, median blood loss was 6,300 (range, 750-21,000) ml, and hospitalization was 17 (range, 4-65) days. Overall major and minor complication rates were 34% and 57%, respectively. The in-hospital mortality rate was 1%. A complete resection was possible in 75% of all patients, a microscopically incomplete resection (R1) in 16%, and a macroscopically incomplete resection (R2) in 9%. Fiveyear local control for primary locally advanced rectal cancer, recurrent rectal cancer, and cervical cancer was 89%, 38%, and 64%, respectively. Overall survival after 5 years for primary locally advanced rectal cancer, recurrent rectal cancer, and cervical cancer was 66%, 8%, and 45%. Conclusions Total pelvic exenteration is accompanied with considerable morbidity, but good local control and acceptable overall survival justifies the use of this extensive surgical technique in most patients, especially patients with primary locally advanced rectal cancer and recurrent cervical cancer.

Prevalence of Local Recurrence of Colorectal Cancer at the Iranian Cancer Institute

“…Recurrence in rectal carcinoma is scarcely tolerable for patients because there is a higher risk of permanent stoma that may lead to pelvic exenteration and increased morbidity in patients because of deep pelvic abscess, delay in perineum healing and leakage (Wiig et al, 2007;Ferenschild et al, 2009). Andreoni et al (2007) showed that recurrence in rectal cancer is significantly higher than with colon cancer (14% versus 6.1%; p<000.1).…”

Total Infralevatorian Exenteration with Vulvectomy as Salvage Therapy in a Recurrent Irradiated Cervical Cancer with Pelvic Sidewall Involvement

“…The survival rates at 5 years for primary advanced rectal malignancy, recurrent rectal tumours and tumors of the uterine cervix were 66%, 8% and 45%, respectivley. 11 Wydra et al reported a mortality rate of 7%, of which intraoperative mortality accounted for 3.5%. 12 Major postoperative complications include bleeding, infection, wound dehiscence, and anastomotic leak in the intestines, urinary pouch or ureteral sites.…”

Late results of treatment and quality of life in women after pelvic exenteration

“…конти-нентный гетеротопический резервуар из слепой киш-ки с умбиликостомой -3 (3,3 %), W-образная илео-цистопластика по Hautmann -8 (8,7 %), операция Bricker -58 (63,0 %); ректосигмопластика Mainz pouch чеиспускательного канала), задняя экзентерация -ор-ганов задней части полости малого таза (репродуктив-ных органов и нижних отделов кишечника), а тотальная экзентерация включает одновременное выполнение передней и задней экзентерации. Данная операция, особенно тотальная экзентерация, ассоциирована со значительной частотой осложнений, высокой ле-тальностью и снижением качества жизни пациенток [6,7]. Поэтому для оптимизации результатов тазовой эк-зентерации важнейшее значение имеет всесторонняя оценка различных аспектов ее применения, что и опре-деляет актуальность настоящего исследования.…”