Division of Surgical Oncology, Department of Surgery, Arthur G, James Cancer Hospital and Richard J, Solove Research Institute and Comprehensive Cancer Center, Wexner Medical Center, The Ohio State University, 395 W 12th Ave, Room 654, Columbus, OH 43210, USA.
World J Surg Oncol. 2012 Jun 15;10:110. doi: 10.1186/1477-7819-10-110.
In patients with locally advanced or recurrent pelvic malignancies, total pelvic exenteration (TPE) may be necessary for curative treatment. Despite improvements in mortality rates since TPE was first described, morbidity rates remain high due to the extensive resection and the aggressiveness of these tumors. We have studied the outcomes of TPE surgery performed at our institution.
Fifty-three patients with various pelvic pathologies underwent TPE between 2004 and 2010. Patients were divided into two groups based on pathology: colorectal (n = 36) versus non-colorectal (n = 17) malignancies. Demographics, operative reports, pathology reports, periprocedural events, and outcomes were analyzed. Comparison of the two groups was performed using student's t-test and Fisher's exact test. Survival curves were constructed using the Kaplan-Meier method and compared using the log rank test.
The colorectal and non-colorectal groups were similar in demographics, operative times, length of stay, estimated blood loss, and rates of preoperative and intraoperative radiation use. Chemotherapy use was increased in the colorectal group compared with the non-colorectal group (55.6% vs. 23.5%, P = 0.04). Complication rates were similar: 86% in the colorectal group and 76% in the non-colorectal group. In the colorectal group, 27.8% of patients developed perineal abscesses, whereas no patients developed these complications in the non-colorectal group (P = 0.02). No survival difference was seen in primary versus recurrent colorectal tumors; however, within the colorectal group there was a survival advantage when comparing R0 resection to R1 and R2 resection combined. Median survival rates were 27.3 months for R0 resection and 10.7 months for R1 and R2 resection combined. The median survival was 21.4 months for the colorectal group and 6.9 months for the non-colorectal group (P = 0.002).
Patients undergoing TPE for colorectal tumors have improved survival when compared with patients undergoing exenteration for pelvic malignancies of other origins. Within the colorectal group, the extent of resection demonstrated a significant survival benefit of an R0 resection compared with R1 and R2 resections. Despite TPE carrying a high morbidity rate, mortality rates have improved and careful patient selection can optimize outcomes.
对于局部晚期或复发性盆腔恶性肿瘤患者，根治性治疗可能需要进行全盆腔切除术（TPE）。尽管自 TPE 首次描述以来，死亡率有所改善，但由于广泛的切除和这些肿瘤的侵袭性，发病率仍然很高。我们研究了我们机构进行的 TPE 手术的结果。
2004 年至 2010 年间，53 例患有各种盆腔疾病的患者接受了 TPE。根据病理将患者分为两组：结直肠（n = 36）与非结直肠（n = 17）恶性肿瘤。分析了患者的人口统计学资料、手术报告、病理报告、围手术期事件和结果。使用学生 t 检验和 Fisher 确切检验比较两组。使用 Kaplan-Meier 方法构建生存曲线，并使用对数秩检验进行比较。
结直肠组和非结直肠组在人口统计学、手术时间、住院时间、估计失血量以及术前和术中放疗使用率方面相似。与非结直肠组相比，结直肠组的化疗使用率更高（55.6% vs. 23.5%，P = 0.04）。并发症发生率相似：结直肠组为 86%，非结直肠组为 76%。在结直肠组中，27.8%的患者发生会阴脓肿，而在非结直肠组中没有发生这些并发症（P = 0.02）。原发性和复发性结直肠肿瘤之间未见生存差异；然而，在结直肠组中，比较 R0 切除与 R1 和 R2 联合切除时，生存优势更为明显。R0 切除的中位生存时间为 27.3 个月，R1 和 R2 联合切除的中位生存时间为 10.7 个月。结直肠组的中位生存时间为 21.4 个月，非结直肠组的中位生存时间为 6.9 个月（P = 0.002）。
与因其他起源的盆腔恶性肿瘤而行 TPE 的患者相比，因结直肠肿瘤而行 TPE 的患者的生存时间得到改善。在结直肠组中，与 R1 和 R2 切除相比，R0 切除的切除范围具有显著的生存获益。尽管 TPE 发病率较高，但死亡率已有所改善，仔细选择患者可以优化结果。
