title: Pelvic exenteration for recurrent squamous cell carcinoma of the pelvic organs arising from the cloaca--a single institution's experience over 16 years.
abstract: OBJECTIVE
  Minimal data are available on the role of pelvic exenteration in patients with recurrent squamous cell carcinoma (SCC) of the pelvic organs. This study aimed to highlight our experience of pelvic exenteration in patients with recurrent and re-recurrent SCC of the pelvic organs.
  
  
  METHODS
  A retrospective review of all patients who underwent pelvic exenteration for recurrent SCC of the pelvic organs arising from the embryological cloaca from 1994 to 2010 was performed.
  
  
  RESULTS
  Twenty-four patients (median age 59, range, 27-79 years) underwent pelvic exenteration for recurrent SCC of the anus (18), cervix and upper vagina (2), lower vagina (1) and the vulva (3). Nine patients with anal SCC had undergone abdominoperineal excision prior to pelvic exenteration. Ten (41.7%) patients underwent a complete pelvic exenteration procedure, while sacrectomy was performed in 13 (54.2%) patients. There was no 30-day inpatient mortality. An R0 resection was achieved in 15 (62.5%) patients. Three (12.5%) had R1 resections while 6 (25%) had R2 resections. In the 15 patients with an R0 resection, 7 (46.7%) developed metastatic disease at a median of 18 (range 10-131) months. After a median follow-up of 26 (range 4-169) months, 1- and 2-year overall survival rates were 64% [95% confidence interval (CI), 44-84%] and 57% (95% CI 35-79%), respectively.
  
  
  CONCLUSIONS
  Pelvic exenteration for recurrent SCC of the cloaca is safe and feasible even after previous salvage surgery. An R0 resection can be achieved in 62.5% of the patients with reasonable early survival though less than published recurrent rectal cancer studies.
authors.affiliation: Department of Colorectal Surgery, Royal Prince Alfred Hospital, Sydney, New South Wales, Australia.
authors.forename: K K
authors.initials: KK
authors.lastname: Tan
authors.forename: S
authors.initials: S
authors.lastname: Pal
authors.forename: P J
authors.initials: PJ
authors.lastname: Lee
authors.forename: L
authors.initials: L
authors.lastname: Rodwell
authors.forename: M J
authors.initials: MJ
authors.lastname: Solomon
mesh_terms: D000328:Adult; D000368:Aged; D001003:Anal Canal / Q000196:embryology; D001005:Anus Neoplasms / Q000473:pathology / Q000601:surgery*; D002294:Carcinoma, Squamous Cell / Q000556:secondary / Q000601:surgery*; D002584:Cervix Uteri / Q000196:embryology; D005260:Female; D005833:Genital Neoplasms, Female / Q000473:pathology / Q000601:surgery*; D006801:Humans; D008297:Male; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local / Q000601:surgery*; D018365:Neoplasm, Residual; D010385:Pelvic Exenteration; D012189:Retrospective Studies; D015996:Survival Rate; D002583:Uterine Cervical Neoplasms / Q000473:pathology / Q000601:surgery; D014621:Vagina / Q000196:embryology; D014625:Vaginal Neoplasms / Q000473:pathology / Q000601:surgery; D014844:Vulva / Q000196:embryology; D014846:Vulvar Neoplasms / Q000473:pathology / Q000601:surgery
keywords: Exenteration; anus; cloaca; pelvis; squamous cell carcinoma