title: Pelvic exenteration for the treatment of locally advanced colorectal and bladder malignancies in the modern era.
abstract: BACKGROUND
  Although pelvic exenteration (PE) remains an important treatment for advanced pelvic malignancies, it has historically been associated with high morbidity and mortality with unclear long-term benefits. The objectives of this study were (1) estimate complication and mortality rates, (2) determine predictors of complications, and (3) estimate overall survival after PE for patients with locally advanced colorectal and bladder tumors.
  
  
  METHODS
  A total of 377 patients were retrospectively identified from the 2005-2010 NSQIP PUF and an additional 1,111 from the 2004-2010 Surveillance Epidemiology and End Results database with T4M0 colorectal or bladder cancers. A logistic regression model was fitted to estimate early morbidity and mortality. The Kaplan-Meier method was used to estimate survival after PE compared to nonoperative management.
  
  
  RESULTS
  Fifty-seven percent of patients had a complication, but 30-day mortality was only 2%. Patients with preoperative dyspnea and higher ASA class had the highest risk of morbidity. PE for the treatment of T4M0 rectal and bladder cancer was associated with significantly improved long-term survival compared to nonoperative therapy.
  
  
  CONCLUSIONS
  PE is associated with a high complication rate but low 30-day mortality. The results of this study provide strong evidence to support PE as a viable treatment option for locally advanced rectal and bladder malignancies in appropriately selected patients.
authors.affiliation: Department of Surgery, Duke University, Durham, NC, USA.
authors.forename: Paul J
authors.initials: PJ
authors.lastname: Speicher
authors.forename: Ryan S
authors.initials: RS
authors.lastname: Turley
authors.forename: Jason L
authors.initials: JL
authors.lastname: Sloane
authors.forename: Christopher R
authors.initials: CR
authors.lastname: Mantyh
authors.forename: John
authors.initials: J
authors.lastname: Migaly
mesh_terms: D000368:Aged; D015179:Colorectal Neoplasms / Q000473:pathology* / Q000601:surgery*; D016208:Databases, Factual; D004417:Dyspnea / Q000150:complications; D005260:Female; D006801:Humans; D015994:Incidence; D008297:Male; D008875:Middle Aged; D009367:Neoplasm Staging; D010385:Pelvic Exenteration / Q000009:adverse effects* / Q000401:mortality*; D019106:Postoperative Hemorrhage / Q000453:epidemiology; D012189:Retrospective Studies; D012307:Risk Factors; D018426:SEER Program; D018805:Sepsis / Q000453:epidemiology; D012720:Severity of Illness Index; D013530:Surgical Wound Infection / Q000453:epidemiology; D015996:Survival Rate; D014481:United States / Q000453:epidemiology; D001749:Urinary Bladder Neoplasms / Q000473:pathology* / Q000601:surgery*; D014552:Urinary Tract Infections / Q000453:epidemiology