title: Determinants of survival following pelvic exenteration for primary rectal cancer.
abstract: BACKGROUND
  Pelvic exenteration is a potentially curative treatment for locally advanced primary rectal cancer. Previous studies have been limited by small sample sizes and heterogeneous data. A consecutive series of patients was studied to identify the clinicopathological determinants of survival.
  
  
  METHODS
  All patients undergoing pelvic exenterative surgery for primary rectal cancer (1992-2014) at this hospital were analysed. The primary outcome measure was 5-year overall survival. Secondary endpoints included length of hospital stay, complication rate, 30-day mortality and disease recurrence rate. Statistical analysis was performed using Kaplan-Meier and Cox regression analysis.
  
  
  RESULTS
  A total of 174 patients with a median age of 65 (range 31-90) years were included. Ninety-six patients underwent posterior pelvic exenteration and 78 had total pelvic exenteration. Median follow-up was 48 (range 1-229) months. Two patients (1.1 per cent) died within 30 days of surgery and 16.1 per cent returned to the operating theatre. The 5-year survival rate following complete resection (R0) was 59.3 per cent. In univariable analysis, adverse survival was associated with advanced age (P = 0.003), metastatic disease (P = 0.001), pathological node status (P = 0.001), circumferential resection margin (P = 0.001), local recurrence (P = 0.015) and the need for neoadjuvant therapy (P = 0.039).
  
  
  CONCLUSIONS
  Pelvic exenteration is an aggressive treatment option with a high morbidity rate that provides favourable long-term outcomes in patients with locally advanced primary rectal cancer.
authors.affiliation: Abertawe Bro Morgannwg University Local Health Board, Swansea, UK.
authors.forename: R W
authors.initials: RW
authors.lastname: Radwan
authors.affiliation: Abertawe Bro Morgannwg University Local Health Board, Swansea, UK.
authors.forename: H G
authors.initials: HG
authors.lastname: Jones
authors.affiliation: Abertawe Bro Morgannwg University Local Health Board, Swansea, UK.
authors.forename: N
authors.initials: N
authors.lastname: Rawat
authors.affiliation: Abertawe Bro Morgannwg University Local Health Board, Swansea, UK.
authors.forename: M
authors.initials: M
authors.lastname: Davies
authors.affiliation: Abertawe Bro Morgannwg University Local Health Board, Swansea, UK.
authors.forename: M D
authors.initials: MD
authors.lastname: Evans
authors.forename: D A
authors.initials: DA
authors.lastname: Harris
authors.forename: J
authors.initials: J
authors.lastname: Beynon
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D005500:Follow-Up Studies; D017052:Hospital Mortality / Q000639:trends; D006801:Humans; D008297:Male; D008875:Middle Aged; D009367:Neoplasm Staging; D010385:Pelvic Exenteration / Q000401:mortality*; D012004:Rectal Neoplasms / Q000175:diagnosis / Q000401:mortality / Q000601:surgery*; D012189:Retrospective Studies; D018570:Risk Assessment / Q000379:methods*; D012307:Risk Factors; D015996:Survival Rate / Q000639:trends; D013997:Time Factors; D006113:United Kingdom / Q000453:epidemiology