title: Total pelvic exenteration for the treatment of advanced primary or recurrent pelvic neoplasia.
abstract: BACKGROUND
  Complete resection with clear margins in locally advanced pelvic visceral tumors, primary or recurrent, occasionally requires total pelvic exenteration (TPE).
  
  
  METHODS
  We reviewed the results of EFA in 34 consecutive patients operated on between June 2006 and December 2013.
  
  
  RESULTS
  Median age was 62 (40-82) years; 24 (70%) were male. The tumor origin most frequent was advanced primary rectal tumor (APRT), with 19 cases (55.9%) and most common type of exenteration was supraelevator (61.8%). R₀ resection was achieved in 24 (70.6%) patients and in 16 (85%) of the APRT. Fifteen (79%) patients had pT₄ APRT, and 4 (20%) pN +. Reconstruction of the bowel and bladder was performed with two stomas in 17 cases (50%), colorectal anastomosis and Bricker in 11 (32.3%) and wet double barreled colostomy in 6 (17.6%). There was no postoperative mortality; 23 (67,5%) patients had complications, and 5 (14.6%) required a postoperative reoperation to solve them. Median follow-up was 23 (13-45) months. Overall survival (OS) and disease free survival (DFS) at 2 years were 67% and 58% respectively, and the median OS and DFS was 59 months (95% CI 26-110) and 39 months (95% CI 14-64), respectively. The DFS of R₀ was significantly better (p=0.003) than R₁.
  
  
  CONCLUSIONS
  TPE is a potentially curative procedure for advanced pelvic visceral malignancies with similar morbi-mortality than other extended excisional surgery.
authors.affiliation: Sección de Cirugía Colorrectal, Hospital Universitario Donostia, Donostia-San Sebastián, España.
authors.forename: Laura
authors.initials: L
authors.lastname: Carballo
authors.affiliation: Servicio de Cirugía General y Digestiva, Hospital Universitario Donostia, Donostia-San Sebastián, España. Electronic address: josemaria.enriqueznavascues@osakidetza.net.
authors.forename: José M
authors.initials: JM
authors.lastname: Enríquez-Navascués
authors.affiliation: Sección de Cirugía Colorrectal, Hospital Universitario Donostia, Donostia-San Sebastián, España.
authors.forename: Yolanda
authors.initials: Y
authors.lastname: Saralegui
authors.affiliation: Sección de Cirugía Colorrectal, Hospital Universitario Donostia, Donostia-San Sebastián, España.
authors.forename: Carlos
authors.initials: C
authors.lastname: Placer
authors.affiliation: Sección de Cirugía Colorrectal, Hospital Universitario Donostia, Donostia-San Sebastián, España.
authors.forename: Ander
authors.initials: A
authors.lastname: Timoteo
authors.affiliation: Sección de Cirugía Colorrectal, Hospital Universitario Donostia, Donostia-San Sebastián, España.
authors.forename: Nerea
authors.initials: N
authors.lastname: Borda
authors.affiliation: Sección de Cirugía Colorrectal, Hospital Universitario Donostia, Donostia-San Sebastián, España.
authors.forename: Alberto
authors.initials: A
authors.lastname: Carrillo
authors.affiliation: Sección de Cirugía Colorrectal, Hospital Universitario Donostia, Donostia-San Sebastián, España.
authors.forename: Aitor
authors.initials: A
authors.lastname: Sainz-Lete
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D018572:Disease-Free Survival; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local / Q000401:mortality / Q000601:surgery*; D010385:Pelvic Exenteration; D010386:Pelvic Neoplasms / Q000401:mortality / Q000601:surgery*; D012189:Retrospective Studies; D015996:Survival Rate
keywords: Advanced cancer; Cáncer avanzado; Cáncer de recto; Exenteración pélvica; Neoplasias pélvicas; Pelvic exenteration; Pelvic malignancies; Rectal cancer