N. M. Hinkle1, P. Dickson1, R. B. Interiano1, D. Shibata1, G. Munene4, J. Monroe1, L. Smiley2, M. Reed2, J. Deneve1 1University Of Tennessee Health Science Center,Surgery,Memphis, TN, USA 2University Of Tennessee Health Science Center,Obstetrics And Gynecology,Memphis, TN, USA 3University Of Tennessee Health Science Center,Medical Oncology,Memphis, MS, USA 4West Michigan Cancer Center,Surgery,Kalamazoo, MI, USA
Introduction: Locally advanced gastrointestinal and gynecologic malignancies can be managed with curative intent surgery in appropriately selected patients. We review the outcomes of patients undergoing pelvic exenteration (PEx) for these neoplasms.
Methods: An IRB-approved retrospective review was performed of patients with primary and recurrent disease undergoing PEx with clinicopathologic variables and perioperative outcomes described.
Results: Forty-two patients underwent PEx: median age 55.1 years, female (71%), Caucasian (67%), prior chemotherapy (79%). Pathology included the rectum (36%), colon (17%), ovary (12%), and other (35%). Type of PEx performed included: anterior (10%), posterior (55%) and total exenteration (36%). Median operative time was 499 minutes (167-893). Urinary diversion was performed in 43%. Median hospital stay was 11.5 days (6-27). Overall complication rate was 57% with major morbidity associated with 33% of the cases and multiple complications occurring in 26%. There was also one 30-day mortality (2.4%). Adjuvant chemotherapy was administered to 64%. Eighteen (43%) suffered from local recurrence and 26% developed distant metastases. At a median follow up of 18 months (0-84), 45% were alive without disease, 24% alive with disease, 24% dead of disease and 7% dead of other causes. Median recurrence free survival (RFS) was 25 months and overall survival (OS) was not reached. RFS at 1- and 5-years was 84% and 31% with 1- and 5-year OS being 80% and 58%, respectively.
Conclusion: Aggressive resection with PEx is possible with acceptable morbidity and outcome. A multidisciplinary approach with PEx is a sound treatment option for appropriately selected patients with gastrointestinal and gynecologic malignancies.