Primary pelvic exenteration for locally advanced pelvic malignancies

Abstract

Background: Pelvic exenteration can be performed in selected patients with large pelvic malignancies as a primary treatment with curative intention. This study aimed to share our experience of primary pelvic exenterations, which were performed in a single institution between November 2011 and July 2020, enroling 23 patients with different types of pelvic cancers.Results: The patients mean age was 55 years (range: 43-72 years) and the oncological indications were: stage IVa cervical cancer (11 cases, 48.9%), stage IVa endometrial cancer (1 case, 4.3 %), stage IVa vaginal cancer (6 cases, 26%), stage IIIb bladder cancer (3 cases, 13%), stage IIIc rectal cancer (1 case, 4.3%) and undifferentiated pelvic sarcoma (1 case, 4.3%). Total, anterior, and posterior pelvic exenterations have consisted of 34.4%, 56.5% and 13% of cases, respectively. Related to levator ani muscle, 13 (56.5%) pelvic exenterations were supralevatorian, 10(43.5%) infralevatorian, and 5 (21.7%) were infralevatorian with vulvectomy. No major intraoperative complications have occured. Seven patients (30.5%) have developed early complications, and 4 of them (17.4%) have required reoperation. One (4.3 %) perioperative death caused by a pulmonary embolism was recorded and one patient had a late complication represented by a urostomy stenosis. Over a median follow-up period of 35 months, 8 (34.8%) patients have died. The median overall survival (OS) was 33 months (range 1-96 months). The 2-year and 5-year survival rates were 72% and 66% respectively. Univariate analysis showed that margin status was the only factor significantly associated with disease-free survival (DFS) (p=0.016). Conclusion: Primary pelvic exenteration can be related with various postoperative complications, without high perioperative morality and with long-term survival.