Pelvic exenteration for locally advanced and recurrent rectal cancer: long-term outcomes and prognostic factors

Introduction: Pelvic exenteration is a radical treatment for locally advanced and recurrent pelvic tumors. The aim of this study was to analyze the perioperative and long-term outcomes of patients undergoing pelvic exenteration for rectal cancer at a referral center in Mexico City. Method: We included all patients who underwent pelvic exenteration due to rectal cancer between 1995 and 2019. Demographic, clinical, surgical and pathological variables were analyzed. Results: 18 patients were included (16 locally advanced and 2 recurrent). The male-female ratio was 1:3.5. The highest morbidity was 27.7%. Intraoperative bleeding >= 1000 ml was associated with postoperative morbidity (80 vs. 20%; p = 0.029) and mortality (100 vs. 0; p = 0.043). The median overall survival was 102 months. Overall survival and disease free survival at 5 years after exenteration were 44.4% and 38.8%, respectively. Lymphovascular invasion of the tumor was a poor prognostic factor for disease free survival (p = 0.017). Conclusions: Pelvic exenteration for rectal cancer is a surgical procedure with high morbidity and mortality. Lymphovascular invasion is a poor prognostic factor for disease-free survival.