The future of the pelvic exenteration patient

Abstract

Pelvic exenterations (PE) as extended operations, removing advanced tumor to the pelvic organs, result in substantial changes in patients - formed are bowel and/or urinary stomas; huge pelvic cavity. The main paradigms: PE or palliation? Quality of life or duration of life? We aim to define what is the future of the PE patient after such traumatic operation? What factors determine the survival of PE patients - tumour type (location, spread, primary or relapse, histopathology); operative trauma; postoperative complications; relapses; quality of life? For 1992-2011, we had 181 PE patients - 56 total, 69 posterior, 47 anterior; 8 median - advanced primary or relapse rectal, urological and genital carcinomas. Radical PE - 122 and palliative PE - 59. Palliations in 47 non-resectable cases. We compare complications and survival rates for radical and palliative PE patients; and palliations only. Intraoperative mortality is 0%. Postoperative mortality is 6%. The major early postoperative complications and late complications (6 weeks after operation) are listed. Gastrointestinal - 18%; urinary - 48%; pelvic floor - 44%. Survival followed in 71 radical PE patients: 12 months - 37; 18 months - 9; 2 years - 12; 48 months - 8; 5 years - 5 patients. Palliative PE - up to 18 months. Palliation cases - 2 to 6 months. Intraoperative and postoperative mortality rates are low. Almost every patient develops at least one complication, approximately 40-50% experience a major complication. Urinary complications are the most common, especially urinary infections. Relapse development is the next life-limitation factor after radical PE. Palliative PE patients have significantly higher morbidity and lower survival rates than radical ones. Reported 5-year survival rates after PE range 23-61% (16% for our patients). The main factors determining the future of PE patients are operation type - radical/palliative PE; postoperative morbidity; relapses. The most common complication is urinary infection.