AB099. Pelvic exenteration for primary and recurrent malignancies in urology department

OBJECTIVE: For locally advanced and recurrent pelvic malignancies, radical margins are sometimes difficult to obtain because of close relation to or growth in adjacent organs/structures. Pelvic exenteration (PE) could be an extensive operation for these advanced tumors and involves en bloc resection of the bladder, and internal genital organs (prostate/seminal vesicles or uterus, ovaries and/or vagina) or sometimes rectum (TPE). The objective of present study is to investigate the safety and efficacy of PE for the treatment of pelvic malignancies in urology department. METHODS: From April 2010 to December 2014, 20 patients with primary or recurrent pelvic malignancy accepted PE or total PE surgery in Urology Department of Peking University First Hospital. The operations were carried out by one surgery group (Dr. Xi and Dr. Zhou). The resection of bladder, prostate for male (uterus for female) and rectum was defined as TPE and the resection of bladder and uterus as APE. The perioperative characters, pathological results and patients’ survival were collected and analyzed. RESULTS: There were seven males and 13 females in this study with an average age of 65. Ten case accepted APE and 10 for TPE. There were six cases primary tumor in APE group and three primary tumors in TPE. The average operation time for APE was 3.79 hours and 5.20 hours for TPE (P>0.05). Median length of hospital stay was 17.9 [7-47] days. The median blood loss was 300 mL (80-2,500 mL) for APE and 400 mL (50-6,000 mL) for TPE (P>0.05). The ilium conduit was done in five cases for APE and six cases for TPE (P>0.05) as urinary diversion. The median follow-up time was 12.5 months (1-41 months). The estimated 2-year survival rate for APE was 55.6% and 45% for TPE (P>0.05). CONCLUSIONS: PE (APE and TPE) in urology clinical application could be a safe and reliable choice for local advanced primary and recurrent pelvic malignancy. With the development of surgery equipment and techniques, the intraoperative blood loss, complications and risk of operation was significant reduced. The tumor control and survival results of the patients were comparable and satisfactory.