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Outcomes following repeat exenteration for locally advanced pelvic malignancy
Joshua Blake1,2, Cherry E Koh1,2,3,4, Daniel Steffens1,2
1Surgical Outcomes Research Centre (SOuRCe), Royal Prince Alfred Hospital, Sydney, NSW, Australia.
Summary
Repeat pelvic exenteration for recurrent malignancy is feasible but offers no survival advantage. This procedure is linked to higher complication rates and longer hospital stays, questioning its therapeutic value.
Area of Science:
- Oncology
- Surgical Oncology
- Pelvic Malignancy
Background:
- Pelvic exenteration is a radical surgical procedure for advanced pelvic malignancies.
- Repeat pelvic exenterations (second, third) are performed for recurrent disease.
Purpose of the Study:
- To assess surgical outcomes and survival after first, second, and third pelvic exenterations.
- To compare outcomes between patients undergoing repeat exenterations versus primary exenteration.
Main Methods:
- Retrospective review of 642 pelvic exenterations performed between 1994 and 2017.
- Comparison of demographics and surgical outcomes using generalized mixed modelling.
- Survival analysis using Cox proportional hazards models and Kaplan-Meier plots.
Main Results:
- Repeat exenterations (2nd: 4.5%, 3rd: 0.9%) were more likely for asymptomatic recurrences.
- Postoperative complications (6% to 33%) and length of stay (27 to 48 days) increased with repeat procedures.
- Median survival from the most recent exenteration was 4.75 years (1st), 2.02 years (2nd), and 1.45 years (3rd).
Conclusions:
- Repeat pelvic exenteration is feasible but associated with increased complications and hospital stay.
- R0 margin achievement is reduced in repeat exenterations.
- Repeat exenteration does not provide a survival benefit over a single exenteration, suggesting questionable therapeutic value.
