Pelvic Exenteration: Surgical Aspects and Analysis of Early and Late Morbidity in a Series of 106 Patients.

INTRODUCTION

The aim of this study was to report the surgical results in a series of pelvic exenterations, its peroperative difficulties, postoperative complications, mortality and long-term complications.

PATIENTS AND METHODS

Between November 1980 and December 2008, pelvic exenteration with curative intent has been performed in 106 patients, 87 female and 19 male, for gynecologic malignancy in 69, intestinal tumors in 29, urologic in 6 and advanced skin carcinomas in 2. The exenteration was performed as primary treatment in only 21 patients, in the others it was for persistent or recurrent tumors after radiotherapy and/or surgery.

RESULTS

In 86 patients a total exenteration was performed and in 55 the resection involved an extension beyond the classical planes of dissection. An incontinent urinary diversion was made in 100 patients, a colo-anal anastomis in 35, omentoplasty was standard and muscle flaps were used in 15 patients. Blood loss necessitating transfusion of more than 10 packed cell units or gauze packing did occur in 27 patients with extended resection. Postoperative complications occurred in 64 patients necessitating relaparotomy in 14. Mortality within 30 days was 2%, in hospital 5% but did not occur in the last 44 patients. During the very long follow-up serious late complications were observed in the kidneys of 12 patients and in the small bowel of 5.

CONCLUSIONS

Pelvic exenteration is still a major surgical undertaking with a 60% complication rate but can nowadays be performed with a low mortality. Postoperative complications were related to radiotherapy dose above 50 Gy, extension of dissection, the empty pelvis, the urinary diversion and the small intestine. A protected colo-anal anastomosis should be offered when the pelvic floor can be conserved and muscle flaps should be considered after total infralevatoric exenteration. Bricker's urinary diversion still is the golden standard. Long-term complications were observed in 40 patients requiring surgery in 19.