Pelvic Exenteration With Rectal Resection for Different Types of Malignancies at Two Tertiary Referral Centers

Abstract

IntroductionPelvic exenteration (PE) offers the best chance of cure for locally advanced primary or recurrent pelvic organ malignancies invading adjacent organs. The aims of this study were to analyze results for any pelvic exenteration that includes rectal resection and the analysis of results of fecal and urinary reconstruction. MethodFrom January 2000 to April 2014, 111 PE with rectal resection for any pelvic cancer were analyzed retrospectively at two national tertiary referral centers. ResultsThirty-six colorectal anastomosis were performed. Urologic reconstructions performed were 30 double barrelled wet colostomy (DBWC), 14 Bricker ileal conduit (BIC), and 2 ureterocutaneostomies. Postoperative complications occurred in 71 patients (64%). Six deaths (5.4%) occurred within 30 postoperative days. 5-Year overall survival following R0 resection was 62.6%; R1, 42.7%; R2: 24.2% (P=.018). The resection margin status was associated with overall survival, local recurrence and distant recurrence. ConclusionPelvic exenterations for any cause need to be performed in referral centers and by specialized surgeons. Anastomosis after modified supralevator pelvic exenteration for ovarian cancer, is safe. DBWC can be considered a valid option for urologic reconstruction. The most important prognostic factor after pelvic exenteration for malignant pelvic tumors is the status of surgical margins.