Pelvic exenteration: A perspective from a regional cancer center in India

BACKGROUND: Pelvic exenteration is an extensive surgical procedure performed for locally advanced cancers in the pelvis.
AIMS: The twenty-year experience with this procedure at the Cancer Institute has been analyzed for morbidity, failure pattern and survival.
SETTINGS AND DESIGN: The case records of all the patients who had undergone pelvic exenteration between 1981 and 2000 at Cancer Institute (WIA), Chennai were retrieved from Tumor Registry and were analyzed.
METHODS AND MATERIAL: Forty-eight patients underwent Pelvic Exenteration from 1981 to 2000 at the institute. Twenty-nine of them had rectal cancer, 15 had cervical cancer, 3 had bladder cancer, and 1 had ovarian cancer. There were 43 women and 5 men with a median age of 45 years.
STATISTICAL ANALYSIS: The survival rates were calculated by Kaplan-Meier method using EGRET statistical software package.
RESULTS: The operative mortality and postoperative morbidity were 10.42% and 62.50% respectively. The 5-year overall survival for the patients with Ca rectum and Ca cervix were 54.2% and 77.6% respectively. All 4 patients with Ca bladder or Ca ovary survived for more than 5 years. On multivariate analysis, nodal involvement and number of positive nodes emerged as significant prognostic factors for patients with Ca rectum. Although no factor reached statistical significance for patients with Ca cervix, those with adjacent organ invasion had a trend towards poorer survival.
CONCLUSIONS: For carefully selected locally advanced cancer in the pelvis, pelvic exenteration may provide the opportunity of long-term survival.