Short‐ and long‐term outcomes of selective pelvic exenteration surgery in a low‐volume specialized tertiary setting

• Published in: ANZ journal of surgery Vol. 89; no. 6; pp. E226 - E230
• Main Authors: Humphries, Emily L., Kroon, Hidde M., Dudi‐Venkata, Nagendra N., Thomas, Michelle L., Moore, James W., Sammour, Tarik
• Format: Journal Article
• Language: English
• Published: Melbourne John Wiley & Sons Australia, Ltd 01.06.2019; Blackwell Publishing Ltd
• Subjects: Adenocarcinoma; colorectal; Malignancy; Median (statistics); Patients; pelvic exenteration; Rectum; Statistical analysis; Surgery; Survival; colorectal; pelvic exenteration
• ISSN: 1445-1433; 1445-2197
• DOI: 10.1111/ans.15212

Background Most published data on pelvic exenteration comes from high‐volume quaternary units, with limited data available from outside of this setting. This study reports outcomes of selective pelvic exenteration performed in a low‐volume tertiary unit with multidisciplinary support. Methods A retrospective review of consecutive patients who underwent pelvic exenteration surgery for rectal/anal carcinoma, or gynaecological malignancy at Royal Adelaide Hospital between June 2008 and September 2018. Descriptive statistics and Kaplan–Meier analysis of 5‐year disease‐free and overall survival for patients treated with curative intent were performed. Results A total of 54 patients who underwent pelvic exenteration were included. Most patients presented with primary rectal adenocarcinoma, and posterior and total pelvic exenterations were the most common operations performed (>90%). Median total operating time was 323 min, median hospital stay was 15 days, and the readmission rate was 14.8%. The overall complication rate (per patient) was 70.4%, and the re‐intervention rate was 20.4%. Thirteen percent of patients required intensive care unit‐admission, and there was one postoperative death (1.9%). R0 resection margins were achieved in 81.5% of patients, with R1 and R2 margins in 13.0 and 5.6% of patients, respectively. Estimated 5‐year disease‐free survival was 38.8%, and 5‐year overall survival was 65.7%. Conclusion Short‐ and long‐term outcomes of selective pelvic exenteration surgery are acceptable in a low‐volume specialized tertiary setting with suitable multidisciplinary expertise. If the required expertise is not readily available, then outside referral is recommended. A retrospective review of consecutive patients who underwent pelvic exenteration surgery for rectal/anal carcinoma, or gynaecological malignancy at Royal Adelaide Hospital between June 2008 and September 2018. A total of 54 patients who underwent pelvic exenteration were included and short and long‐term outcomes of selective pelvic exenteration surgery were found to be acceptable in a low‐volume specialised tertiary setting with suitable multidisciplinary expertise.