title: Lateral pelvic compartment excision during pelvic exenteration.
abstract: BACKGROUND
  Involvement of the lateral compartment remains a relative or absolute contraindication to pelvic exenteration in most units. Initial experience with exenteration in the authors' unit produced a 21 per cent clear margin rate (R0), which improved to 53 per cent by adopting a novel technique for en bloc resection of the iliac vessels and other side-wall structures. The objective of this study was to report morbidity and oncological outcomes in consecutive exenterations involving the lateral compartment.
  
  
  METHODS
  Patients undergoing pelvic exenteration between 1994 and 2014 were eligible for review.
  
  
  RESULTS
  Two hundred consecutive patients who had en bloc resection of the lateral compartment were included. R0 resection was achieved in 66·5 per cent of 197 patients undergoing surgery for cancer and 68·9 per cent of planned curative resections. For patients with colorectal cancer, a clear resection margin was associated with a significant overall survival benefit (P = 0·030). Median overall and disease-free survival in this group was 41 and 27 months respectively. Overall 1-, 3- and 5-year survival rates were 86, 46 and 35 per cent respectively. No predictors of survival were identified on univariable analysis other than margin status and operative intent. Excision of the common or external iliac vessels or sciatic nerve did not confer a survival disadvantage.
  
  
  CONCLUSIONS
  The continuing evolution of radical pelvic exenteration techniques has seen an improvement in R0 margin status from 21 to 66·5 per cent over a 20-year interval by routine adoption of a more lateral anatomical plane. Five-year overall survival rates are comparable with those for more centrally based tumours.
authors.affiliation: Surgical Outcomes Research Centre (SOuRCe), Sydney Local Health District and Sydney School of Public Health, University of Sydney, New South Wales, Australia.|Department of Colorectal Surgery, Royal Prince Alfred Hospital, New South Wales, Australia.|Institute of Academic Surgery at Royal Prince Alfred Hospital, Sydney Local Health District, New South Wales, Australia.|Discipline of Surgery, University of Sydney, Sydney, New South Wales, Australia.
authors.forename: M J
authors.initials: MJ
authors.lastname: Solomon
authors.affiliation: Surgical Outcomes Research Centre (SOuRCe), Sydney Local Health District and Sydney School of Public Health, University of Sydney, New South Wales, Australia.
authors.forename: K G M
authors.initials: KG
authors.lastname: Brown
authors.affiliation: Surgical Outcomes Research Centre (SOuRCe), Sydney Local Health District and Sydney School of Public Health, University of Sydney, New South Wales, Australia.|Department of Colorectal Surgery, Royal Prince Alfred Hospital, New South Wales, Australia.|Institute of Academic Surgery at Royal Prince Alfred Hospital, Sydney Local Health District, New South Wales, Australia.
authors.forename: C E
authors.initials: CE
authors.lastname: Koh
authors.affiliation: Surgical Outcomes Research Centre (SOuRCe), Sydney Local Health District and Sydney School of Public Health, University of Sydney, New South Wales, Australia.|Department of Colorectal Surgery, Royal Prince Alfred Hospital, New South Wales, Australia.
authors.forename: P
authors.initials: P
authors.lastname: Lee
authors.affiliation: Surgical Outcomes Research Centre (SOuRCe), Sydney Local Health District and Sydney School of Public Health, University of Sydney, New South Wales, Australia.|Department of Colorectal Surgery, Royal Prince Alfred Hospital, New South Wales, Australia.
authors.forename: K K S
authors.initials: KK
authors.lastname: Austin
authors.affiliation: Surgical Outcomes Research Centre (SOuRCe), Sydney Local Health District and Sydney School of Public Health, University of Sydney, New South Wales, Australia.
authors.forename: L
authors.initials: L
authors.lastname: Masya
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D015179:Colorectal Neoplasms / Q000401:mortality / Q000601:surgery*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D009517:New South Wales / Q000453:epidemiology; D010385:Pelvic Exenteration / Q000379:methods*; D012189:Retrospective Studies; D015996:Survival Rate / Q000639:trends; D016896:Treatment Outcome; D055815:Young Adult