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

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.