Composite pelvic resection. An approach to advanced pelvic cancer.

The definition of resectability has changed in the management of advanced pelvic malignancy. Most tumors previously considered unresectable can be removed by a function-preserving composite resection of the pelvis. We have performed resection in 55 such patients. Most had posterior pelvic tumors (47 patients), had previously undergone irradiation, and required a combined sacral resection. Included were patients with recurrent or locally advanced rectal cancer (32 patients), epidermoid cancer of the anorectum (seven patients), and primary pelvic malignancies (eight patients). Most had good functional recovery. The five-year actuarial survival rate was 23% (five of 25 patients survived longer than 51 months) in the patients with resected rectal cancer and 14% (one of seven patients) in the patients with resected anorectal carcinoma. Five of eight patients with primary tumors survived longer than 48 months. Lateral pelvic resections were done for five tumors that involved the ileum or ischium, and anterior resection was done in three patients for malignancy that involved the symphysis and rami. Four of these patients were living three to six years after surgery. The overall mortality rate was 7% (four of 55 patients). Composite pelvic resections can provide good local control with preservation of limb function in most patients with primary or secondary tumors of the bony pelvis.