Pelvic exenteration for colorectal and non-colorectal cancer: a comparison of perioperative and oncological outcome

• DOI: 10.1007/s00384-021-03893-y
• Publication Date: 2021-03-07T05:38:17Z
• Authors: Andreas Bogner; Johannes Fritzmann; Benjamin Müssle; Johannes Huber; Jakob Dobroschke; Ulrich Bork; Steffen Wolk; Marius Distler; Jürgen Weitz; Thilo Welsch; Christoph Kahlert
• Keywords: Surgical complication ; Pelvic exenteration ; Anus Neoplasms [MeSH] ; Recurrence ; Humans [MeSH] ; Pelvic Exenteration/adverse effects [MeSH] ; Treatment Outcome [MeSH] ; Retrospective Studies [MeSH] ; Neoplasm Recurrence, Local/surgery [MeSH] ; Rectal Neoplasms/surgery [MeSH] ; Original Article ; Survival ; Rectal cancer; Rectal Neoplasms; Anus Neoplasms; Pelvic Exenteration; 3. Good health; 03 medical and health sciences; Treatment Outcome; 0302 clinical medicine; Humans; Original Article; Neoplasm Recurrence, Local; Retrospective Studies

AbstractBackgroundPelvic exenteration (PE) is the only option for long-term cure of advanced cancer originating from different types of tumor or recurrent disease in the lower pelvis. The aim was to show differences between colorectal and non-colorectal cancer in survival and postoperative morbidity.MethodsRetrospective data of 63 patients treated with total pelvic exenteration between 2013 and 2018 are reported. Pre-, intra-, and postoperative parameters, survival data, and risk factors for complications were analyzed.ResultsA total of 57.2% (n= 37) of the patients had colorectal cancer, 22.3% had gynecological malignancies (vulvar (n= 6) or cervical (n= 8) cancer), 11.1% (n= 7) had anal cancer, and 9.5% had other primary tumors. A total of 30.2% (n= 19) underwent PE for a primary tumor and 69.8% (n= 44) for recurrent cancer. The 30-day in-hospital mortality was 0%. Neoadjuvant treatment was administered to 65.1% (n= 41) of the patients and correlated significantly with postoperative complications (odds ratio 4.441; 95% CI: 1.375–14.342,P> 0.05). R0, R1, R2, and Rx resections were achieved in 65.1%, 19%, 1.6%, and 14.3% of the patients, respectively. In patients undergoing R0 resection, 2-year OS and RFS were 73.2% and 52.4%, respectively. Resection status was a significant risk factor for recurrence-free and overall survival (OS) in univariate analysis. Multivariate analysis revealed age (P= 0.021), ASA ≥ 3 (P= 0.005), high blood loss (P= 0.028), low preoperative hemoglobin level (P< 0.001), nodal positivity (P< 0.001), and surgical complications (P= 0.003) as independent risk factors for OS.ConclusionPelvic exenteration is a procedure with high morbidity rates but remains the only curative option for advanced or recurrent colorectal and non-colorectal cancer in the pelvis.