J. K. Kim1, J. Patel1, M. Billah3, N. Suri4, O. Mahmoud2, R. Chokshi1 1New Jersey Medical School,Surgical Oncology,Newark, NJ, USA 2New Jersey Medical School,Radiation Oncology,Newark, NJ, USA 3New Jersey Medical School,Urology,Newark, NJ, USA 4New Jersey Medical School,Medicine,Newark, NJ, USA
Introduction:
Pelvic exenteration is a radical operation offered to patients with locally advanced primary or recurrent pelvic malignancy in an attempt to improve survival. However, it is unclear whether the extent of pelvic exenteration affects outcome. In this study, we compared the patient demographics and surgical outcomes of patients who underwent total and nontotal pelvic exenterations.
Methods:
With Institutional Review Board approval, we performed a retrospective analysis of patients who underwent pelvic exenterations for treatment of various advanced malignancies between 2005 and 2017. Patients were divided into total pelvic exenteration (TPE) and nontotal pelvic exenteration (NTE) which included anterior pelvic and posterior pelvic exenterations. TPE involved excision of the rectum, bladder, and if applicable, the female reproductive organs, followed by a urinary and fecal diversion. Anterior pelvic exenteration involved removal of the urinary tract requiring urinary diversion. Posterior pelvic exenteration involved removal of the rectum, requiring fecal diversion. Survival was monitored by follow up visits. Complications were reported according to Clavien-Dindo classification. T-test for continuous variables and Chi-square test for categorical variables were employed with p<0.05 for statistical significance.
Results:
Sixteen patients underwent TPE and seven patients underwent NTE. Baseline demographics of both groups were similar. Mean ages for TPE and NTE group were 58.4 years and 61.9 years respectively (p =0.426). Gender distribution and distribution of ethnicity were also similar in both groups (p=0.266 and p=0.591 respectively). Mean body mass index, however, was significantly lower in the TPE group compared to the NTE group (23.4 and 29.8 respectively with p=0.015). Double barrel wet colostomy was the most common form of urinary and fecal diversion for TPE (62.5%) while ileal-conduit or end colostomy were the most common forms of urinary or fecal diversion in the NTE. There was a significantly higher six month overall survival in the TPE group (75%) compared to NTE group (43%); (p=0.0404). Long term survival data was not available due to poor follow up. TPE had a tendency for higher class I/II Clavien-Dindo complications (54%) compared to NTE (14%); (p=0.0849). Rate of class III/IV Clavien-Dindo classifications were similar in TPE and NTE (31% and 43% respectively with p=0.589). Urinary tract infection was the most common postoperative complication in both groups (56% in TPE, 71% in NTE, p= 0.493) followed by sepsis (37.5%, 28.5% respectively with p=0.679).
Conclusion:
Patients that underwent TPE compared to NTE had a lower body mass index. Severity of complications between the two groups did not differ. Infection was the most common complication in both TPE and NTE. TPE had a lower mortality at six months compared to NTE but long term overall survival still needs to be determined.