title: Cystoprostatectomy versus prostatectomy alone for locally advanced or recurrent pelvic cancer.
abstract: BACKGROUND
  There is minimal published data evaluating the oncological outcome of rectal resection with prostatectomy alone versus rectal resection with cystoprostatectomy in patients undergoing pelvic exenteration for locally advanced or recurrent pelvic cancer. This study aims to evaluate the oncological and functional outcomes of performing rectal resection with prostatectomy alone compared with rectal resection with cystoprostatectomy in patients undergoing pelvic exenteration.
  
  
  METHODS
  Consecutive patients undergoing pelvic exenteration for locally advanced or recurrent pelvic cancer between 1998 and 2012 were identified from a prospectively maintained database. Patients undergoing rectal resection with prostatectomy alone were compared with a control group who underwent rectal resection with cystoprostatectomy and urostomy formation. The primary outcome was overall survival. Secondary outcomes analysed in the prostatectomy group included completeness of resection, continence and erectile function.
  
  
  RESULTS
  Eleven rectal resections with prostatectomy were compared with 20 rectal resections with cystoprostatectomy. R0 resection was achieved in 73 and 65% respectively. There was no difference in overall survival (P = 0.40). Urinary continence was achieved in 36% of prostatectomy alone patients, while 27% experienced mild incontinence. Erectile function was poor, with only one patient able to maintain normal erections.
  
  
  CONCLUSIONS
  In appropriately selected patients with invasive pelvic tumours, rectal resection with prostatectomy alone provides adequate oncological outcomes. The ability to achieve an R0 resection was not compromised and overall survival is comparable with cystoprostatectomy. Urinary function is reasonable in most patients, although sexual function is compromised in almost all.
authors.affiliation: Department of Surgery, Christchurch Hospital, Christchurch, New Zealand.|University of Otago, Christchurch, New Zealand.
authors.forename: Greg A
authors.initials: GA
authors.lastname: Turner
authors.affiliation: Department of Surgery, Christchurch Hospital, Christchurch, New Zealand.|University of Otago, Christchurch, New Zealand.
authors.forename: Craig A
authors.initials: CA
authors.lastname: Harris
authors.affiliation: Department of Surgery, Christchurch Hospital, Christchurch, New Zealand.|University of Otago, Christchurch, New Zealand.
authors.forename: Tim W
authors.initials: TW
authors.lastname: Eglinton
authors.affiliation: Department of Surgery, Christchurch Hospital, Christchurch, New Zealand.|University of Otago, Christchurch, New Zealand.
authors.forename: Chris J
authors.initials: CJ
authors.lastname: Wakeman
authors.affiliation: Department of Surgery, Christchurch Hospital, Christchurch, New Zealand.|University of Otago, Christchurch, New Zealand.
authors.forename: Frank
authors.initials: F
authors.lastname: Kueppers
authors.affiliation: Department of Surgery, Christchurch Hospital, Christchurch, New Zealand.|University of Otago, Christchurch, New Zealand.
authors.forename: Liane
authors.initials: L
authors.lastname: Dixon
authors.affiliation: Department of Surgery, Christchurch Hospital, Christchurch, New Zealand.|University of Otago, Christchurch, New Zealand.
authors.forename: Bruce R
authors.initials: BR
authors.lastname: Dobbs
authors.affiliation: Department of Surgery, Christchurch Hospital, Christchurch, New Zealand.
authors.forename: Frank A
authors.initials: FA
authors.lastname: Frizelle
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D015653:Cystectomy / Q000379:methods* / Q000706:statistics & numerical data; D007172:Erectile Dysfunction / Q000453:epidemiology / Q000209:etiology; D006801:Humans; D053208:Kaplan-Meier Estimate; D008297:Male; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local / Q000453:epidemiology / Q000601:surgery*; D009520:New Zealand / Q000453:epidemiology; D010385:Pelvic Exenteration / Q000379:methods / Q000706:statistics & numerical data; D010386:Pelvic Neoplasms / Q000453:epidemiology / Q000601:surgery*; D011468:Prostatectomy / Q000379:methods* / Q000706:statistics & numerical data; D012004:Rectal Neoplasms / Q000453:epidemiology / Q000601:surgery*; D012189:Retrospective Studies; D016896:Treatment Outcome; D014549:Urinary Incontinence / Q000453:epidemiology / Q000209:etiology; D013520:Urologic Surgical Procedures / Q000379:methods / Q000706:statistics & numerical data
keywords: cystoprostatectomy; incontinence; multivisceral resection; pelvic exenteration; rectal cancer