title: Surgical results of pelvic exenteration in the treatment of gynecologic cancer.
abstract: BACKGROUND
  Our aim in the present study was to evaluate surgical outcomes and complications of pelvic exenteration in the treatment of gynecologic malignancy and to compare surgery-related complications associated with different types of exenteration.
  
  
  METHODS
  We performed a retrospective analysis of patients who underwent pelvic exenteration for the treatment of gynecologic cancer between January 2008 and August 2011. Patients were divided into two groups for comparison: total pelvic exenteration (TPE) and nontotal pelvic exenteration (NTE, including anterior pelvic exenteration (APE) posterior pelvic exenteration (PPE)). Outcomes are reported according to the modified Clavien-Dindo Classification of Surgical Complications.
  
  
  RESULTS
  Twenty-eight patients were included in the analysis. Eighteen had cervical cancer (64.3%). The prevalence of stage IIIB cervical cancer was 55%. Primary treatment with radiotherapy was performed in 53.3% of patients. Fifty percent of patients underwent TPE, 25% had APE and 25% underwent PPE. Patients who underwent TPE had worse outcomes, with a mean operative time of 367 minutes, use of blood transfusion in 93% of patients, ICU stay of 4.3 days and total hospital stay of 9.4 days. The overall mortality rate was 14.3%, and the surgical site infection rate was 25%. In the TPE group, 78.6% of patients experienced surgical complications. One-fourth of the total patient sample required reoperation, and the leading cause was urinary fistula (57.1%). Urinary leakage occurred in 22.7% of urinary reconstruction patients. Wet colostomy was the most common form of reconstruction with 10% of leakage.
  
  
  CONCLUSIONS
  Postoperative urinary and infectious complications accounted for 75% of all causes of morbidity and mortality after pelvic exenteration. TPE is a more complex and morbid procedure than NTE.
authors.affiliation: Surgical Oncology, Department of Surgery, Erasto Gaertner Hospital, Curitiba, Brazil. petruzziello123@hotmail.com.
authors.forename: Andrea
authors.initials: A
authors.lastname: Petruzziello
authors.forename: William
authors.initials: W
authors.lastname: Kondo
authors.forename: Sergio B
authors.initials: SB
authors.lastname: Hatschback
authors.forename: João A
authors.initials: JA
authors.lastname: Guerreiro
authors.forename: Flávio Panegalli
authors.initials: FP
authors.lastname: Filho
authors.forename: Cristiano
authors.initials: C
authors.lastname: Vendrame
authors.forename: Murilo
authors.initials: M
authors.lastname: Luz
authors.forename: Reitan
authors.initials: R
authors.lastname: Ribeiro
mesh_terms: D000328:Adult; D000368:Aged; D005260:Female; D005500:Follow-Up Studies; D005833:Genital Neoplasms, Female / Q000150:complications / Q000473:pathology / Q000601:surgery*; D006801:Humans; D008875:Middle Aged; D009367:Neoplasm Staging; D010385:Pelvic Exenteration / Q000009:adverse effects*; D011183:Postoperative Complications; D011379:Prognosis; D012189:Retrospective Studies; D014552:Urinary Tract Infections / Q000209:etiology*