Outcomes following repeat exenteration for locally advanced pelvic malignancy.

AIMS This study aims to assess surgical outcomes and survival following first, second, and third pelvic exenteration for pelvic malignancies. METHODS Consecutive patients undergoing pelvic exenteration for pelvic malignancy at a quaternary referral centre from January 1994 and December 2017 were included. Demographics and surgical outcomes were compared between patients that underwent first, second, and third pelvic exenteration by generalized mixed modelling with repeated measures. Survival was assessed using Cox proportional hazards models and Kaplan-Meier plots. RESULTS Of the 642 exenterations reviewed, 29 (4.5%) were second, and 6 (0.9%) were third exenterations. Patients selected for repeat exenteration were more likely to have asymptomatic local recurrences detected on routine surveillance (p<0.001). Post-operative wound complications increased with repeat exenteration (6%, 17%, 33%; p=0.003, respectively). Additionally, post-operative length of stay increased from 27 to 38 and 48 days, respectively (p=0.004). Median survival from first exenteration was 4.75 years, 5.30 years, and 8.14 years respectively amongst first, second, and third exenteration cohorts (p=0.849). Median survival from most recent exenteration was 4.75 years after a first exenteration, 2.02 years after a second exenteration, and 1.45 years after a third exenteration (p=0.0546). CONCLUSION This study demonstrates that repeat exenteration for recurrent pelvic malignancy is feasible but is associated with increased complication rates, length of admission, and reduced likelihood of attaining R0 margin. Moreover, these data indicate that repeat exenteration does not afford a survival advantage compared to single exenteration patients. These data suggest that repeat exenteration for recurrent pelvic malignancy may be of questionable therapeutic value.