Modified posterior pelvic exenteration for ovarian cancer.
BACKGROUND
A modified posterior pelvic exenteration (MPE) might be needed to reach an optimal tumoral reduction. The issue of this study is to relate a multicentric experience of this kind of resection.


METHODS
Three hundred five patients who needed an MPE were analyzed from 9 French cancer centers. One hundred sixty-eight MPEs were performed during initial surgery (55.1%), 69 during interval surgery (22.6%), 36 after chemotherapy (11.8%), and 32 for recurrences (10.5%).


RESULTS
Three hundred two colorectal anastomoses were realized with a protective stoma in 59 (19.5%) of cases and a stoma closure in 76.5% (51). The rate of functional anastomosis was 96% (290/302). Complications occurred in 26.9% (82/305) of the patients, with a fistula in 25 (8.2%). The reintervention rate was 8.8% (27/305). The median length of hospitalization was 15 days. The absence of a macroscopic residual disease was obtained in 58% (173/303) of cases. A residual disease that was 1 cm or smaller was observed in 73 cases (24%) and 2 cm or smaller observed in 36 (11.9%). Postoperative chemotherapy was started with a median time of 32 days.Postoperative death occurred in 1 patient (0.33%). The survival rates were 62.7% and 27.6% at 2 and 5 years, respectively. With a multivariate analysis, the 2 significant prognostic factors were residual disease and time of surgery (P < 0.0001).


CONCLUSIONS
A rectal invasion should not be an obstacle to reach the aim to obtain a macroscopic minimal residual disease or, if possible, the absence of one. An MPE is useful in those cases to reach optimal cytoreduction, with comparable results whatever the patient's age is. A temporary protective stoma should be considered only exceptionally.
Houvenaeghel
Gilles
G
Service de Chirurgie Oncologique 2, Institut Paoli-Calmettes, Marseille, France. houvenag@marseille.fnclcc.fr
Gutowski
Martin
M
Buttarelli
Max
M
Cuisenier
Jean
J
Narducci
Fabrice
F
Dalle
Christian
C
Ferron
Gwenael
G
Morice
Phillippe
P
Meeus
Pierre
P
Stockle
Eberhart
E
Bannier
Marie
M
Lambaudie
Eric
E
Rouanet
Phillippe
P
Fraisse
Jean
J
Leblanc
Eric
E
Dauplat
Jacques
J
Querleu
Denis
D
Martel
Pierre
P
Castaigne
Damien
D
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000714:Anastomosis, Surgical; D013505:Digestive System Surgical Procedures; D005260:Female; D006801:Humans; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local; D018365:Neoplasm, Residual; D010051:Ovarian Neoplasms / Q000401:mortality / Q000601:surgery*; D010385:Pelvic Exenteration; D011183:Postoperative Complications; D011379:Prognosis; D012189:Retrospective Studies; D015996:Survival Rate; D016896:Treatment Outcome; D055815:Young Adult