Andreas Bogner1, Johannes Fritzmann2, Thilo Welsch2, Christoph Kahlert2, Benjamin Müssle2, Johannes Huber3, Jakob Dobroschke4, Ulrich Bork2, Steffen Wolk2, Marius Distler2, Jürgen Weitz2. 1. Department of Visceral, Thoracic and Vascular Surgery, Faculty of Medicine Carl Gustav Carus, Technische Universität Dresden, Fetscherstrasse 74, 01307, Dresden, Germany. Andreas.Bogner@uniklinikum-dresden.de. 2. Department of Visceral, Thoracic and Vascular Surgery, Faculty of Medicine Carl Gustav Carus, Technische Universität Dresden, Fetscherstrasse 74, 01307, Dresden, Germany. 3. Department of Urology, Faculty of Medicine Carl Gustav Carus, Technische Universität Dresden, Dresden, Germany. 4. Department of General, Visceral, Thoracic and Proctologic Surgery, Helios Klinikum Pirna, Pirna, Germany.
Abstract
BACKGROUND: Pelvic exenteration (PE) is the only option for long-term cure of advanced cancer originating from different types of tumor or recurrent disease in the lower pelvis. The aim was to show differences between colorectal and non-colorectal cancer in survival and postoperative morbidity. METHODS: Retrospective data of 63 patients treated with total pelvic exenteration between 2013 and 2018 are reported. Pre-, intra-, and postoperative parameters, survival data, and risk factors for complications were analyzed. RESULTS: A total of 57.2% (n = 37) of the patients had colorectal cancer, 22.3% had gynecological malignancies (vulvar (n = 6) or cervical (n = 8) cancer), 11.1% (n = 7) had anal cancer, and 9.5% had other primary tumors. A total of 30.2% (n = 19) underwent PE for a primary tumor and 69.8% (n = 44) for recurrent cancer. The 30-day in-hospital mortality was 0%. Neoadjuvant treatment was administered to 65.1% (n = 41) of the patients and correlated significantly with postoperative complications (odds ratio 4.441; 95% CI: 1.375-14.342, P > 0.05). R0, R1, R2, and Rx resections were achieved in 65.1%, 19%, 1.6%, and 14.3% of the patients, respectively. In patients undergoing R0 resection, 2-year OS and RFS were 73.2% and 52.4%, respectively. Resection status was a significant risk factor for recurrence-free and overall survival (OS) in univariate analysis. Multivariate analysis revealed age (P = 0.021), ASA ≥ 3 (P = 0.005), high blood loss (P = 0.028), low preoperative hemoglobin level (P < 0.001), nodal positivity (P < 0.001), and surgical complications (P = 0.003) as independent risk factors for OS. CONCLUSION: Pelvic exenteration is a procedure with high morbidity rates but remains the only curative option for advanced or recurrent colorectal and non-colorectal cancer in the pelvis.
BACKGROUND: Pelvic exenteration (PE) is the only option for long-term cure of advanced cancer originating from different types of tumor or recurrent disease in the lower pelvis. The aim was to show differences between colorectal and non-colorectal cancer in survival and postoperative morbidity. METHODS: Retrospective data of 63 patients treated with total pelvic exenteration between 2013 and 2018 are reported. Pre-, intra-, and postoperative parameters, survival data, and risk factors for complications were analyzed. RESULTS: A total of 57.2% (n = 37) of the patients had colorectal cancer, 22.3% had gynecological malignancies (vulvar (n = 6) or cervical (n = 8) cancer), 11.1% (n = 7) had anal cancer, and 9.5% had other primary tumors. A total of 30.2% (n = 19) underwent PE for a primary tumor and 69.8% (n = 44) for recurrent cancer. The 30-day in-hospital mortality was 0%. Neoadjuvant treatment was administered to 65.1% (n = 41) of the patients and correlated significantly with postoperative complications (odds ratio 4.441; 95% CI: 1.375-14.342, P > 0.05). R0, R1, R2, and Rx resections were achieved in 65.1%, 19%, 1.6%, and 14.3% of the patients, respectively. In patients undergoing R0 resection, 2-year OS and RFS were 73.2% and 52.4%, respectively. Resection status was a significant risk factor for recurrence-free and overall survival (OS) in univariate analysis. Multivariate analysis revealed age (P = 0.021), ASA ≥ 3 (P = 0.005), high blood loss (P = 0.028), low preoperative hemoglobin level (P < 0.001), nodal positivity (P < 0.001), and surgical complications (P = 0.003) as independent risk factors for OS. CONCLUSION: Pelvic exenteration is a procedure with high morbidity rates but remains the only curative option for advanced or recurrent colorectal and non-colorectal cancer in the pelvis.
Authors: Gustavo A Laporte; Lucas A G Zanini; Paulo H Zanvettor; Alexandre F Oliveira; Enio Bernado; Fernando Lissa; Manoel J P Coelho; Reitan Ribeiro; Raphael L C Araujo; Abner J J Barrozo; Alexandre F da Costa; Amario P de Barros Júnior; Andre Lopes; Antônio P M Santos; Bruno R B Azevedo; Bruno J Q Sarmento; Carlos A M Marins; Carlos M B Loureiro; Cezar A V Galhardo; Charles N Gatelli; Claudio A Quadros; Cláudio V Pinto; Diego N A O Uchôa; Diogo R S Martins; Eduardo Doria-Filho; Ellen K M A Ribeiro; Eric R F Pinto; Evandro A S Dos Santos; Francisco A M Gozi; Francisco C Nascimento; Francisco G Fernandes; Francisco K L Gomes; Geraldo J S Nascimento; Guilherme O Cucolicchio; Guilherme F Ritt; Guilherme G de Oliveira; Gunther P Ayala; Gustavo C Guimarães; Gustavo C Ianaze; Gustavo A Gobetti; Gustavo M Medeiros; Gustavo Z Güth; Heládio F C Neto; Higino F Figueiredo; João C Simões; José C Ferrari; José P R Furtado; Leonardo J Vieira; Lucas F Pereira; Luiz C F de Almeida; Muhamed R A Tayeh; Pedro H M Figueiredo; Rafael S A V Pereira; Ramon O Macedo; Raquel M M Sacramento; Rayane M Cardoso; Renato M Zanatto; Rodrigo A M Martinho; Rodrigo G Araújo; Rodrigo N Pinheiro; Rosilene J Reis; Sergio B S Goiânia; Sergio R P Costa; Tariane F Foiato; Tyrone C Silva; Vandré C G Carneiro; Viviane R Oliveira; William A Casteleins Journal: J Surg Oncol Date: 2019-11-27 Impact factor: 3.454
Authors: Dieter Hahnloser; Heidi Nelson; Leonard L Gunderson; Imran Hassan; Michael G Haddock; Michael J O'Connell; Stephen Cha; Daniel J Sargent; Alan Horgan Journal: Ann Surg Date: 2003-04 Impact factor: 12.969