TOTAL PELVIC EXENTERATION - INDICATIONS A ND ACCOMPLISHMENT

From 1988 to 1996 we performed 18 total pelvic exenterations in patien ts with an average age of 59,8 years who could be followed up for a me an 29.8 months. In 10 cases a recurrent tumor of the pelvic viscera an d 7 times a primary carcinoma of the rectum, bladder or prostate were treated. In 1 patient a radiogenic fistula led to this operation. Inte stinal continuity could be reconstructed in 7 cases. Following cystect omy, urinary diversion was accomplished in half of the cases by an ile al conduit. Due to septic multiorgan failure 2 patients died postopera tively (hospital mortality rate 11%). In 82% a complete resection (RO) was possible. Subsequently 5 patients (29%) developed tumor recurrenc e. Distant metastases were observed in 3 patients, 8-9 months after su rgery. So far 10 further patients have died. Their mean survival time was 28.9 months (range 5-99 months). The remaining 6 patients are stil l alive between 22 and 36 months postoperatively. Despite the extent o f this kind of major surgery, which also requires multidisciplinary co operation, and the psychosocial problems resulting from two permanent stomas, total pelvic exenteration should be regarded as an adequate al ternative in the treatment plan in selected patients with locally adva nced or recurrent pelvic disease.