title: Smaller pelvic volume is associated with postoperative infection after pelvic salvage surgery for recurrent malignancy.
abstract: BACKGROUND
  Patients with recurrent pelvic malignancy have few treatment options, and surgery is fraught with complications. We sought to characterize the relationship between radiographic pelvic volume and postoperative complications after pelvic salvage surgery.
  
  
  METHODS
  A retrospective chart review of all patients undergoing pelvic exenteration or abdominoperineal resection for recurrent malignancy between 1998 and 2013 was performed. Preoperative computed tomography was used to determine pelvic volume.
  
  
  RESULTS
  Forty-two patients underwent surgery for recurrent rectal (26, 62%), prostate (8, 19%), or anal squamous cell cancer (8, 19%). Thirty-eight patients (90%) suffered complications and there was one (2%) perioperative death. Decreasing pelvic volume was associated with deep or organ space infections (P = .01), sepsis (P = .03), and fistula (P = .05) on univariate analysis. Infections remained significant on multivariate analysis (odds ratio, 1.01; P = .02).
  
  
  CONCLUSIONS
  Pelvic salvage surgery for recurrent malignancy is associated with a high complication rate yet low mortality. Decreasing pelvic volume is associated with increasing risk of deep or organ space infections.
authors.affiliation: Department of Surgery, University of Colorado, 12631 E 17th Avenue, MSC302, Aurora, CO 80045, USA.
authors.forename: Edward L
authors.initials: EL
authors.lastname: Jones
authors.affiliation: Department of Surgery, University of Colorado, 12631 E 17th Avenue, MSC302, Aurora, CO 80045, USA.
authors.forename: Teresa S
authors.initials: TS
authors.lastname: Jones
authors.affiliation: Department of Surgery, University of Colorado, 12631 E 17th Avenue, MSC302, Aurora, CO 80045, USA.
authors.forename: Alessandro
authors.initials: A
authors.lastname: Paniccia
authors.affiliation: Department of Surgery, University of Colorado, 12631 E 17th Avenue, MSC302, Aurora, CO 80045, USA.
authors.forename: Justin S
authors.initials: JS
authors.lastname: Merkow
authors.affiliation: Department of Radiology, University of Colorado, 12631 E 17th Avenue, MSC302, Aurora, CO 80045, USA.
authors.forename: Daniel M
authors.initials: DM
authors.lastname: Wells
authors.affiliation: Department of Surgery, University of Colorado, 12631 E 17th Avenue, MSC302, Aurora, CO 80045, USA.
authors.forename: Nathan W
authors.initials: NW
authors.lastname: Pearlman
authors.affiliation: Department of Surgery, University of Colorado, 12631 E 17th Avenue, MSC302, Aurora, CO 80045, USA. Electronic address: Martin.McCarter@UCDenver.edu.
authors.forename: Martin D
authors.initials: MD
authors.lastname: McCarter
mesh_terms: D000328:Adult; D000368:Aged; D002294:Carcinoma, Squamous Cell / Q000473:pathology / Q000601:surgery*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local / Q000473:pathology / Q000601:surgery*; D010385:Pelvic Exenteration; D010388:Pelvis / Q000033:anatomy & histology*; D011471:Prostatic Neoplasms / Q000473:pathology / Q000601:surgery*; D012004:Rectal Neoplasms / Q000473:pathology / Q000601:surgery*; D012189:Retrospective Studies; D016879:Salvage Therapy; D013530:Surgical Wound Infection / Q000209:etiology*; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome
keywords: Hostile; Infection; Pelvic salvage; Pelvic volume; Recurrent; Smaller