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Pelvic exenteration for advanced pelvic malignancy.

P J Crowe1, W J Temple, M J Lopez

  • 1Department of Surgical Oncology, Tom Baker Cancer Centre, Calgary, Alberta, Canada. p.crowe@unsw.edu.au

Seminars in Surgical Oncology
|October 3, 1999
PubMed
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Pelvic exenteration offers a potentially curative option for advanced pelvic cancers, especially recurrent cases. Advances in surgical techniques and radiotherapy improve survival and quality of life, making it a viable treatment for otherwise incurable pelvic malignancies.

Area of Science:

  • Surgical Oncology
  • Gynecologic Oncology
  • Colorectal Surgery

Background:

  • Pelvic exenteration is a complex surgical procedure for advanced pelvic cancers, often presenting as recurrence after initial treatments.
  • Patient selection is crucial, with physiological age and absence of comorbidities being more critical than chronological age.
  • Pre-operative imaging (CT/MRI) is vital for staging and identifying unresectable disease.

Purpose of the Study:

  • To review the surgical details and outcomes of pelvic exenteration for advanced pelvic malignancies.
  • To discuss the role of radiotherapy in conjunction with exenteration.
  • To highlight advancements improving patient quality of life post-surgery.

Main Methods:

  • Review of surgical techniques for pelvic exenteration, including composite resections with sacrectomy.

Related Experiment Videos

  • Discussion of reconstructive techniques using tissue flaps (e.g., rectus abdominis) to reduce morbidity.
  • Consideration of intra-operative or postoperative radiotherapy for advanced disease.

    • Main Results:

    • Five-year survival rates vary: 40-60% for gynecologic cancers, 25-40% for colorectal cancers.
    • Peri-operative mortality is 5-10%, with over 50% experiencing significant morbidity.
    • Reconstructive techniques for urinary, gastrointestinal, and vaginal tracts improve quality of life by reducing stoma reliance.

    Conclusions:

    • Pelvic exenteration, particularly with advances in surgical and radiotherapeutic techniques, remains a viable option for selected patients with otherwise incurable pelvic cancers.
    • The primary intent should be curative resection, as the role of palliative exenteration is debated.
    • Improved reconstructive methods enhance functional outcomes and patient well-being.