The role of palliative pelvic exenteration

A retrospective review was made of pelvic exenterative procedures performed over a 45-month period at a single institution for symptom palliation in 35 patients with previously treated pelvic cancers (21 colorectal, 9 urinary, 5 gynecologic). Preexenterative treatment and nutritional and performance status were determined. The impact of the disease and the symptoms on quality of life both before and after exenteration was evaluated. Symptoms leading to exenteration included pain (n = 12), bleeding (n = 11), fistula (n = 7), or obstruction (n = 6) and were present for a median duration of 12 months before surgery. Procedures included 11 total, 13 anterior, and 11 posterior exenterations, with 17 extended resections. Operative mortality was 3% and overall morbidity was 47%. Quality of life improved in 88% of patients after exenteration. Median overall survival was 20 months, and 43% of patients were still alive after a minimum of 16 months of follow-up.