Pelvic exenteration and sphincter preservation: an analysis of 96 cases.
BACKGROUND
Pelvic exenteration (PE) is characterized by its technical complexity and morbidity rate. Appropriate patient selection prior to the operation allows for more conservative surgeries, preserving sphincters, and continent reconstruction of the intestinal and urinary tract, contributing to better results.


METHODS
Between 1980 and 2000, 96 PE were performed. Factors related to sphincter preservation as well as factors associated to prognosis were respectively analyzed.


RESULTS
Of the 96 PE, at least one sphincter in 36 patients was preserved (37.5%). In the 1990s, the sphincter preservation rate was significantly higher than in the 1980s (47.6 vs. 18.2%) (P = 0.005). More serious complications happened in 19.8% of the patients and the post-operative mortality rate was 15.6%. The post-operative complication rate was not influenced by sphincter preservation (P = 0.276). In nine patients, the resection margins were compromised microscopically (R1) and in five patients, there were macroscopically compromised (R2). The resection margins were not influenced by the type of surgery (P = 0.104), nor by the preservation of sphincters (P = 0.881). Twenty-three patients experienced relapses, 13 being local, eight distant, and two local and distant. Disease free survival at 5 years was 40.5%, and the primary site of the tumor was a factor associated to differences in disease free survival (P = 0.027). Overall 5-year survival was 41.9% and was significantly associated to the number of organs compromised (P = 0.040) and sphincter preservation (P = 0.026). Patients who were submitted to R0 type resection had a median survival of 40.9 months, while R1 and R2 type resections had a median 21.2 month survival.


CONCLUSIONS
The appropriate pre-operative selection of the patient and rigorous oncological criteria permit PE to be performed while preserving the sphincters in selected cases, without harming survival rates.
Poletto
Antonio Henrique Oliveira
AH
Pelvic Surgery Department, Centro de Tratamento e Pesquisa, Hospital do Cancer, A.C. Camargo. Sao Paulo, SP, Brazil.
Lopes
Ademar
A
Carvalho
André Lopes
AL
Ribeiro
Edson Augusto
EA
Vieira
René Aloísio da Costa
RA
Rossi
Benedito Mauro
BM
Aguiar
Samuel
S
Guimarães
Gustavo Cardoso
GC
Ferreira
Fabio de Oliveira
Fde O
Nakagawa
Wilson Toshihiko
WT
D000293:Adolescent; D000328:Adult; D000368:Aged; D001003:Anal Canal; D015179:Colorectal Neoplasms / Q000401:mortality / Q000601:surgery*; D018572:Disease-Free Survival; D005260:Female; D005833:Genital Neoplasms, Female / Q000401:mortality / Q000601:surgery*; D006801:Humans; D008297:Male; D008875:Middle Aged; D018579:Patient Selection; D010385:Pelvic Exenteration / Q000379:methods* / Q000401:mortality / Q000706:statistics & numerical data; D010386:Pelvic Neoplasms / Q000401:mortality / Q000601:surgery*; D011183:Postoperative Complications / Q000209:etiology; D011379:Prognosis; D015996:Survival Rate; D001749:Urinary Bladder Neoplasms / Q000401:mortality / Q000601:surgery