title: Outcomes of Pelvic Exenteration with en Bloc Partial or Complete Pubic Bone Excision for Locally Advanced Primary or Recurrent Pelvic Cancer.
abstract: BACKGROUND
  Neoplasms infiltrating the pubic bone have until recently been considered a contraindication to surgery. Paucity of existing published data in regard to surgical techniques and outcomes exist.
  
  
  OBJECTIVE
  This study aims to address outcomes of our recently published technique for en bloc composite pubic bone excision during pelvic exenteration.
  
  
  METHODS
  A prospective database was reviewed to identify patients who underwent a partial or complete pubic bone composite excision over a 12-year period.
  
  
  METHODS
  This study was conducted at a tertiary level exenteration unit.
  
  
  METHODS
  Primary outcomes measured were resection margin and survival. Secondary outcomes included patient and operative demographics, type of cancer, extent of pubic bone excision, morbidity, and 30-day mortality.
  
  
  RESULTS
  Twenty-nine of over 500 patients undergoing exenterations (mean age, 57.9; 20 males) underwent en bloc complete (11 patients) or partial (18 patients) composite pubic bone excision. Twenty-two patients (76%) underwent resection for recurrent as opposed to advanced primary malignant disease of which rectal adenocarcinoma was the most common followed by squamous-cell carcinoma. The median operating time was 10.5 (range, 6-15) hours, and median blood loss was 2971 (range, 300-8600) mL. Seventeen (59%) patients had a concurrent sacrectomy performed mainly S3 and below. A total cystectomy was performed in 26 patients (90%). Fifteen of 20 male patients (75%) had a perineal urethrectomy. A clear (R0) resection margin was achieved in 22 patients (76%) with a 5-year overall survival of 53% after a median follow-up of 3.2 years (r = 1.4-12.3 years). There was no 30-day mortality. Seventy percent of patients experienced morbidity with a pelvic collection the most common.
  
  
  CONCLUSIONS
  This study was limited because it was a retrospective review, it occurred at a single site, and it used a small heterogeneous sample.
  
  
  CONCLUSIONS
  Within the realm of evolving exenteration surgery, en bloc composite pubic bone excision offers results comparable to central, lateral, and posterior compartment excisions, and, as such, is a reasonable strategy in the management of neoplasms infiltrating the pubic bone.
authors: 1 Department of Colorectal Surgery, Royal Prince Alfred Hospital, Camperdown, New South Wales, Australia 2 Surgical Outcomes Research Centre (SOuRCe), Royal Prince Alfred Hospital, Camperdown, New South Wales, Australia 3 Institute of Academic Surgery at Royal Prince Alfred Hospital, Camperdown, New South Wales, Australia 4 Discipline of Surgery, University of Sydney, New South Wales, Australia.
authors: Kirk K S
authors: KK
authors: Austin
authors: Andrew J
authors: AJ
authors: Herd
authors: Michael J
authors: MJ
authors: Solomon
authors: Ken
authors: K
authors: Ly
authors: Peter J
authors: PJ
authors: Lee
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D001859:Bone Neoplasms / Q000401:mortality / Q000556:secondary* / Q000601:surgery; D002277:Carcinoma / Q000401:mortality / Q000556:secondary* / Q000601:surgery; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D000072662:Margins of Excision; D008875:Middle Aged; D012516:Osteosarcoma / Q000401:mortality / Q000556:secondary* / Q000601:surgery; D010385:Pelvic Exenteration / Q000379:methods*; D010386:Pelvic Neoplasms / Q000401:mortality / Q000473:pathology* / Q000601:surgery; D011183:Postoperative Complications / Q000453:epidemiology; D011630:Pubic Bone / Q000601:surgery*; D012189:Retrospective Studies; D016896:Treatment Outcome; D055815:Young Adult