Pelvic exenteration: experience from a rural cancer center in developing world.
BACKGROUND
Pelvic exenteration (PE) is a morbid procedure. Ours is a rural based cancer center limited trained surgical oncology staff. Hence, this audit was planned to evaluate morbidity and outcomes of all patients undergoing PE at our center.


METHODS
This is a IRB approved retrospective audit of all patients who underwent PE at our center from January 2010 to August 2013. The toxicity grades were retrospectively assigned according to the CTCAE version 4.02 criteria. Chi-square test was done to identify factors affecting grades 3-5 morbidity. Kaplan Meier survival analysis has been used for estimation of median PFS and OS.


RESULTS
34 patients were identified, with the median age of 52 years (28-73 years). Total, anterior, posterior, and modified posterior exenterations were performed in 4 (11.8%), 5 (14.7%), 14 (41.2%), and 11 (32.4%) patients, respectively. The median time for surgery was 5.5 hours (3-8 hours). The median blood loss was 500 mL (200-4000 mL). CTCAE version 4.02 grades 3-4 toxicity was seen in nine patients (25.7%). The median estimated progression free survival was 31.76 months (25.13-38.40 months). The 2-year overall survival was 97.14%.


CONCLUSIONS
PE related grades 3-5 morbidity of 25.7% and mortality of 2.9% at our resource limited center are encouraging.
Department of Surgical Oncology, Malabar Cancer Center, Thalassery-Koppalam-Panoor Road, Moozhikkara, Kodiyeri, Thalassery, Kannur, Kerala 670103, India.
Sampada B
SB
Dessai
Department of Surgical Oncology, Malabar Cancer Center, Thalassery-Koppalam-Panoor Road, Moozhikkara, Kodiyeri, Thalassery, Kannur, Kerala 670103, India.
Satheesan
S
Balasubramanian
Department of Clinical Hematology and Medical Oncology, Malabar Cancer Center, Thalassery-Koppalam-Panoor Road, Moozhikkara, Kodiyeri, Thalassery, Kannur, Kerala 670103, India.
Vijay M
VM
Patil
Department of Radiation Oncology, Malabar Cancer Center, Thalassery-Koppalam-Panoor Road, Moozhikkara, Kodiyeri, Thalassery, Kannur, Kerala 670103, India.
Santam
S
Chakraborty
Division of Clinical Research and Biostatistics, Malabar Cancer Center, Thalassery-Koppalam-Panoor Road, Moozhikkara, Kodiyeri, Thalassery, Kannur, Kerala 670103, India.
Atanu
A
Bhattacharjee
Department of Surgical Oncology, Malabar Cancer Center, Thalassery-Koppalam-Panoor Road, Moozhikkara, Kodiyeri, Thalassery, Kannur, Kerala 670103, India.
Syam
S
Vikram
D000328:Adult; D000368:Aged; D002173:Cancer Care Facilities; D003906:Developing Countries; D005260:Female; D005500:Follow-Up Studies; D006780:Hospitals, Rural; D006801:Humans; D007194:India; D008297:Male; D008485:Medical Audit; D008875:Middle Aged; D010385:Pelvic Exenteration / Q000401:mortality; D010386:Pelvic Neoplasms / Q000401:mortality / Q000601:surgery*; D011183:Postoperative Complications / Q000453:epidemiology; D012189:Retrospective Studies; D016019:Survival Analysis; D016896:Treatment Outcome