Pelvic exenteration affords safe and durable treatment for locally advanced XXXX .

@entity1 @entity5 @entity189
BACKGROUND: Treatment of locally advanced @entity189 (LARC) often involves exenterative surgery, which can be associated with high perioperative morbidity and mortality. To assist in @entity1 selection for radical surgery, we sought to determine clinicopathologic factors influencing recurrence and disease-free survival (DFS) of LARC. METHODS: Consecutive @entity1 with LARC undergoing exenterative surgery were retrospectively identified in our institutional database. Factors evaluated included age, sex, primary versus recurrent @entity5 , neoadjuvant or adjuvant chemoradiotherapy, resection margin status, recurrence, time to recurrence, and survival. The primary outcome was DFS. Secondary outcomes were overall survival and perioperative morbidity. RESULTS: A total of 72 @entity1 were identified; median age was 52 years, and median follow-up time was 30 months. The overall complication rate was 43%; rates were similar among the @entity1 with primary (47%) or recurrent (37%) LARC. Primary or recurrent @entity5 status was the only factor significantly predictive of outcome after exenteration. Local recurrence rates were lower in the primary group (primary 22%, recurrent 52%, P = .05). A significant difference in 5-year DFS was found between primary and recurrent @entity5 (52% vs. 13%; P < .01). The median time to recurrence was longer in the @entity1 with primary LARC (17 months vs. 8 months; P < .01). CONCLUSIONS: The complication rates for pelvic exenteration remain high, but the morbidity can typically be managed without a clinically important increase in hospitalization. In primary LARC, an aggressive surgical approach provides most @entity1 5-year DFS. Select @entity1 with recurrent LARC will also benefit from pelvic exenteration.
