title: Pelvic exenterations for specific extraluminal recurrences in the era of total mesorectal excision: is there still a chance for cure?: a single-center review of patients with extraluminal pelvic recurrence for rectal cancer from March 2004 to November 2010.
abstract: BACKGROUND
  The benefits in terms of curative resection and survival of pelvic exenterations for specific extraluminal pelvic recurrences from rectal cancer in the era of total mesorectal excision were assessed.
  
  
  METHODS
  We conducted a single-center review of patients with extraluminal pelvic recurrence from colorectal cancer between March 2004 and November 2010. Twenty-seven pelvic exenterations (13 posterior and 14 total) were performed. Independent predicative factors such as age, sex, local control on first surgery, pelvic sidewall excision, initial International Union Against Cancer (UICC) staging, sphincter-preserving resection at first surgery, tumor presentation on computed tomography and magnetic resonance imaging (pelvis sidewall involvement, number of fixation sites, ureteral involvement), local disease-free interval, previous symptoms, and postoperative treatment were analyzed.
  
  
  RESULTS
  No operative mortality was noted in this series. Overall morbidity rate was 74%; 22% of the patients developed severe complications. Complete surgical clearance (R0) was obtained in 63% of the patients. The rate of R0 resections was lower in total pelvic exenteration (57%) than in posterior pelvic exenteration (69%). Three years overall survival and disease-free survival were 76% and 59%, respectively. Curative resection (R0) was the only independent prognostic factor for overall survival (P = .0016) and disease-free survival (P < .0001).
  
  
  CONCLUSIONS
  Pelvic exenterations for extraluminal pelvic recurrences from rectal cancer afford a high R0 resection rate with acceptable morbidity.
authors.affiliation: Department of Digestive Surgery, Purpan University Hospital, 1 Place Baylac, 31000 Toulouse, France.
authors.forename: Laurent
authors.initials: L
authors.lastname: Ghouti
authors.affiliation: Department of Digestive Surgery, Purpan University Hospital, 1 Place Baylac, 31000 Toulouse, France. Electronic address: pereira31000@gmail.com.
authors.forename: Paulo
authors.initials: P
authors.lastname: Pereira
authors.affiliation: Department of Biostatistics, Institut Claudius Regaud, 20-24 Rue du Pont Saint-Pierre, 31052 Toulouse, France.
authors.forename: Thomas
authors.initials: T
authors.lastname: Filleron
authors.affiliation: Department of Digestive Surgery, Purpan University Hospital, 1 Place Baylac, 31000 Toulouse, France.
authors.forename: Marine
authors.initials: M
authors.lastname: Humeau
authors.affiliation: Department of Digestive Oncology, Purpan University Hospital, 1 Place Baylac, 31000 Toulouse, France.
authors.forename: Rosine
authors.initials: R
authors.lastname: Guimbaud
authors.affiliation: Department of Digestive Surgery, Purpan University Hospital, 1 Place Baylac, 31000 Toulouse, France.
authors.forename: Jannick
authors.initials: J
authors.lastname: Selves
authors.affiliation: Department of Digestive Surgery, Purpan University Hospital, 1 Place Baylac, 31000 Toulouse, France.
authors.forename: Nicolas
authors.initials: N
authors.lastname: Carrere
mesh_terms: D000328:Adult; D000368:Aged; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local / Q000473:pathology / Q000601:surgery; D010385:Pelvic Exenteration; D011183:Postoperative Complications / Q000453:epidemiology; D011379:Prognosis; D012004:Rectal Neoplasms / Q000473:pathology / Q000601:surgery*; D015996:Survival Rate; D016896:Treatment Outcome
keywords: Extraluminal; Local recurrence; Pelvic exenteration; Rectal cancer; Surgery