title: Pelvic exenteration and sphincter preservation: an analysis of 96 cases.
abstract: 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.
authors.affiliation: Pelvic Surgery Department, Centro de Tratamento e Pesquisa, Hospital do Cancer, A.C. Camargo. Sao Paulo, SP, Brazil.
authors.forename: Antonio Henrique Oliveira
authors.initials: AH
authors.lastname: Poletto
authors.forename: Ademar
authors.initials: A
authors.lastname: Lopes
authors.forename: André Lopes
authors.initials: AL
authors.lastname: Carvalho
authors.forename: Edson Augusto
authors.initials: EA
authors.lastname: Ribeiro
authors.forename: René Aloísio da Costa
authors.initials: RA
authors.lastname: Vieira
authors.forename: Benedito Mauro
authors.initials: BM
authors.lastname: Rossi
authors.forename: Samuel
authors.initials: S
authors.lastname: Aguiar
authors.forename: Gustavo Cardoso
authors.initials: GC
authors.lastname: Guimarães
authors.forename: Fabio de Oliveira
authors.initials: Fde O
authors.lastname: Ferreira
authors.forename: Wilson Toshihiko
authors.initials: WT
authors.lastname: Nakagawa
mesh_terms: 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