Clinical and oncological outcomes of pelvic exenteration for rectal and gynaecological malignancies

Sharmaine Yen Ling Quake; Dharmendra Garg; Madan Jha

doi:10.18203/2349-2902.isj20242106

Authors

Sharmaine Yen Ling Quake Department of General Surgery, James Cook University Hospital, South Tees NHS Foundation Trust, United Kingdom
Dharmendra Garg Department of General Surgery, James Cook University Hospital, South Tees NHS Foundation Trust, United Kingdom
Madan Jha Department of General Surgery, James Cook University Hospital, South Tees NHS Foundation Trust, United Kingdom

DOI:

https://doi.org/10.18203/2349-2902.isj20242106

Keywords:

PE, Patient outcomes, Rectal cancer, Gynaecological cancer

Abstract

Background: Pelvic exenteration (PE) is radical surgery which offers prospect of cure for patients with locally advanced pelvic malignancy.

Methods: This is a retrospective cohort study evaluating patient outcomes over six-year period at James Cook University Hospital, a tertiary center in United Kingdom. Primary outcome measures included short-term (90 days) mortality and morbidity. Secondary outcome measures were survival and recurrence. Data was analysed by descriptive statistics and Kaplan-Meier curve used for survival estimation.

Results: Out of 68 patients who underwent PE, 88% (n=61) was for primary locally advanced cancer and 10% (n=7) for recurrent cancer. The 31% (n=21) exenterations were for rectal cancer, 68% (n=46) for gynaecological cancer and 1% (n=1) for bladder cancer. Complete (R0) resection was achieved in 86% rectal exenteration versus 68% in gynaecological exenteration (p=0.1459). The overall 90-day mortality rate was 2.9% (n=2). The 19.1% developed major complications (Clavien-Dindo grades 3a-4). The estimated mean overall survival was 55 months (95% CI, 41-71) for rectal versus 44 months (95% CI, 35-53) for gynaecological (p=0.076). At a median follow-up of 19 months, the local and distal recurrence rate for rectal patients after PE was 4.7% and 14.3% respectively. The 41.3% of gynaecological patients developed recurrence and/ or progression of disease.

Conclusions: PE for rectal and gynaecological cancers has low short-term mortality but is associated with high risks of overall complications, most of which were Clavien-Dindo grades <3. The higher recurrence rate observed in the gynaecological cohort is in keeping with the varying intent of the surgery.

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