Clinical Outcomes of Pelvic Exenteration for Locally Advanced Primary or Recurrent Non─Colorectal Pelvic Malignancies

Objective: The aim of this study was to evaluate the outcomes of patients who underwent extensive pelvic surgery for locally advanced primary or recurrent non─colorectal pelvic malignancies. Patients and methods: We performed a retrospective review of the medical records of 19 patients with non─colorectal pelvic malignancies who underwent extensive surgery at our institution between January 2005 and May 2013. Overall survival and progression─free survival were estimated using the Kaplan─Meier method and compared using the logrank test. Results: With regard to tumor histology, 6 patients (31.6%) had gynecological tumors, 8( 42.1%) had urological tumors, 2( 10.5%) had sarcomas, and 3( 15.8%) had other malignancies. Total pelvic exenteration was performed in 13 patients (68.4%), and other procedures were performed in 6 patients( 31.6%). For all patients, the median operation time and blood loss were 699 min and 2,930 mL, respectively. Complete tumor resection( R0) was achieved in 13 patients( 68.4%), and 16 patients had complications( 84.2%). The median overall survival was 18.5 months for patients who underwent R0 resection, compared with 7.3 months for those who underwent R1/R2 surgery (p=0.113), and the median progression─free survival was 7.3 months for cases of R0 resection, compared with 2.0 months for cases of R1/R2 surgery (p=0.035). Conclusion: Our findings indicate that extensive pelvic surgery may be an optimal treatment for some patients with locally advanced primary or recurrent non─colorectal pelvic malignancies. Careful patient selection according to oncological, anatomical, and patient─related factors may improve the outcomes of patients undergoing this extensive, aggressive pelvic surgical procedure.