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Complications of pelvic exenteration.
Archives of Surgery (Chicago, Ill. : 1960)
|November 1, 1985
Summary
Pelvic exenteration for advanced malignancy leads to high complication rates, particularly after radiotherapy. Reconstruction techniques can significantly reduce these complications, improving patient outcomes.
Area of Science:
- Oncology
- Surgical Oncology
- Reconstructive Surgery
Background:
- Pelvic exenteration is a radical surgical procedure for advanced pelvic malignancies.
- High complication rates are a significant concern following this extensive surgery.
Purpose of the Study:
- To evaluate the complication rates and survival outcomes of pelvic exenteration.
- To identify factors influencing complications, including prior radiotherapy and reconstructive techniques.
Main Methods:
- Retrospective review of 104 patients undergoing pelvic exenteration between 1956 and 1984.
- Analysis of major operative field complications (gastrointestinal, urinary, wound).
- Comparison of complication rates based on prior radiotherapy and reconstructive methods.
Main Results:
- 49% of patients experienced major complications; no association with primary disease, extent, histology, or resection extent.
- Prior pelvic radiotherapy significantly increased complication rates (67% vs. 26%).
- Reconstruction with flaps reduced complications from 82% to 48%; operative mortality was 2.9%, 5-year survival 27%.
Conclusions:
- Pelvic exenteration carries substantial morbidity, with prior radiotherapy being a major risk factor.
- Reconstructive surgery, including omental, colonic, and myocutaneous flaps, can mitigate complications in irradiated patients.
- Despite risks, pelvic exenteration offers a survival option for advanced pelvic cancers, necessitating careful patient selection and management.