title: Pelvic exenteration affords safe and durable treatment for locally advanced rectal carcinoma.
abstract: BACKGROUND
  Treatment of locally advanced rectal carcinoma (LARC) often involves exenterative surgery, which can be associated with high perioperative morbidity and mortality. To assist in patient selection for radical surgery, we sought to determine clinicopathologic factors influencing recurrence and disease-free survival (DFS) of LARC.
  
  
  METHODS
  Consecutive patients with LARC undergoing exenterative surgery were retrospectively identified in our institutional database. Factors evaluated included age, sex, primary versus recurrent tumors, neoadjuvant or adjuvant chemoradiotherapy, resection margin status, recurrence, time to recurrence, and survival. The primary outcome was DFS. Secondary outcomes were overall survival and perioperative morbidity.
  
  
  RESULTS
  A total of 72 patients were identified; median age was 52 years, and median follow-up time was 30 months. The overall complication rate was 43%; rates were similar among the patients with primary (47%) or recurrent (37%) LARC. Primary or recurrent tumor status was the only factor significantly predictive of outcome after exenteration. Local recurrence rates were lower in the primary group (primary 22%, recurrent 52%, P = .05). A significant difference in 5-year DFS was found between primary and recurrent tumor (52% vs. 13%; P < .01). The median time to recurrence was longer in the patients with primary LARC (17 months vs. 8 months; P < .01).
  
  
  CONCLUSIONS
  The complication rates for pelvic exenteration remain high, but the morbidity can typically be managed without a clinically important increase in hospitalization. In primary LARC, an aggressive surgical approach provides most patients 5-year DFS. Select patients with recurrent LARC will also benefit from pelvic exenteration.
authors.affiliation: Department of Surgical Oncology, Unit 444, The University of Texas M. D. Anderson Cancer Center, 1515 Holcombe Boulevard, Houston, Texas 77030, USA.
authors.forename: Christopher J
authors.initials: CJ
authors.lastname: Gannon
authors.forename: Jonathan S
authors.initials: JS
authors.lastname: Zager
authors.forename: George J
authors.initials: GJ
authors.lastname: Chang
authors.forename: Barry W
authors.initials: BW
authors.lastname: Feig
authors.forename: Christopher G
authors.initials: CG
authors.lastname: Wood
authors.forename: John M
authors.initials: JM
authors.lastname: Skibber
authors.forename: Miguel A
authors.initials: MA
authors.lastname: Rodriguez-Bigas
mesh_terms: D000328:Adult; D000367:Age Factors; D000368:Aged; D002277:Carcinoma / Q000601:surgery*; D017024:Chemotherapy, Adjuvant; D018572:Disease-Free Survival; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D020360:Neoadjuvant Therapy; D009364:Neoplasm Recurrence, Local / Q000473:pathology / Q000601:surgery; D009367:Neoplasm Staging; D018579:Patient Selection; D010385:Pelvic Exenteration; D011183:Postoperative Complications; D018714:Radiotherapy, Adjuvant; D012004:Rectal Neoplasms / Q000601:surgery*; D012189:Retrospective Studies; D012449:Safety; D012737:Sex Factors; D015996:Survival Rate; D013997:Time Factors; D016896:Treatment Outcome