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Total pelvic exenteration for primary and recurrent malignancies.
F T J Ferenschild1, M Vermaas, C Verhoef
1Department of Surgical Oncology, Erasmus MC-Daniel den Hoed Cancer Center, Rotterdam, The Netherlands. floferenschild@kpnplanet.nl
World Journal of Surgery
|May 8, 2009
Summary
Total pelvic exenteration (TPE) is a complex surgery for advanced pelvic cancers. While associated with significant morbidity, TPE offers good local control and acceptable survival, particularly for rectal and cervical cancers.
Area of Science:
- Surgical Oncology
- Gastrointestinal Surgery
- Gynecologic Oncology
Background:
- Complete resection is crucial for prognosis in pelvic tumor surgery.
- Locally advanced or recurrent pelvic malignancies often require extensive surgical resection.
- Total pelvic exenteration (TPE) involves en bloc removal of pelvic organs to achieve radical margins.
Purpose of the Study:
- To evaluate the outcomes of Total Pelvic Exenteration (TPE) for advanced pelvic malignancies.
- To assess the feasibility, safety, and efficacy of TPE in a diverse patient cohort.
Main Methods:
- A retrospective analysis of 69 patients who underwent TPE between 1994 and 2008.
- Patients had various pelvic cancers including rectal, cervical, sarcoma, vaginal, and endometrial.
- Neoadjuvant chemotherapy, preoperative radiotherapy, and intraoperative radiotherapy (IORT) were utilized in select cases.
Main Results:
- Median follow-up was 43 months. Surgery involved a median of 448 minutes with significant blood loss and hospitalization.
- Major and minor complication rates were 34% and 57%, respectively, with a 1% in-hospital mortality.
- Complete resection (R0) was achieved in 75% of patients. Five-year local control rates varied by cancer type, with primary locally advanced rectal cancer at 89% and recurrent rectal cancer at 38%.
Conclusions:
- Total pelvic exenteration (TPE) is a high-morbidity procedure but offers valuable oncological benefits.
- Good local control and acceptable survival rates justify TPE for selected patients.
- TPE is particularly beneficial for primary locally advanced rectal cancer and recurrent cervical cancer.
