Abstract
Advanced pelvic cancer is a formidable challenge to surgical resection. These tumors commonly invade the bony pelvis, may involve other viscera, and usually have been irradiated previously. The authors are presenting experience with 76 patients who had composite resection of posterior or lateral pelvic malignancy. Fifty-eight patients had secondary cancers involving the musculoskeletal pelvis. This included 47 patients with advanced carcinoma of the rectum (41 curative, 6 palliative), 10 epidermoid cancers of the anorectum (8) or cervix (2), and 1 bladder cancer. Among the 18 patients with primary pelvic tumors were three patients with chordomas, six with bone tumors (osteosarcoma chondrosarcoma, grade III giant cell tumor), and nine with soft tissue tumors. All required major resection of the sacrum or pelvic side walls, and one half had an additional exenterative procedure. The overall mortality rate was 7.9%. Long-term estimated survival was 24% in patients having curative resection of recurrent rectal cancer, and 22.5% in 10 patients with advanced epidermoid cancer. Fifty per cent of patients with primary bone or soft tissue tumors survived from 13 to 88 months. Most patients had reasonable return of function, and were able to return to work or resume their normal previous lifestyle.
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Selected References
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- Ariel I. M., Shah J. P. The conservative hemipelvectomy. Surg Gynecol Obstet. 1977 Mar;144(3):406–413. [PubMed] [Google Scholar]
- Douglass H. O., Jr, Moertel C. G., Mayer R. J., Thomas P. R., Lindblad A. S., Mittleman A., Stablein D. M., Bruckner H. W. Survival after postoperative combination treatment of rectal cancer. N Engl J Med. 1986 Nov 13;315(20):1294–1295. doi: 10.1056/NEJM198611133152014. [DOI] [PubMed] [Google Scholar]
- Eilber F. R., Grant T. T., Sakai D., Morton D. L. Internal hemipelvectomy--excision of the hemipelvis with limb preservation. An alternative to hemipelvectomy. Cancer. 1979 Mar;43(3):806–809. doi: 10.1002/1097-0142(197903)43:3<806::aid-cncr2820430305>3.0.co;2-y. [DOI] [PubMed] [Google Scholar]
- Fortier G. A., Constable W. C., Meyers H., Wanebo H. J. Preoperative radiation therapy for rectal cancer. An effective therapy in need of a clinical trial. Arch Surg. 1986 Dec;121(12):1380–1385. doi: 10.1001/archsurg.1986.01400120026003. [DOI] [PubMed] [Google Scholar]
- Gunterberg B., Kewenter J., Petersén I., Stener B. Anorectal function after major resections of the sacrum with bilateral or unilateral sacrifice of sacral nerves. Br J Surg. 1976 Jul;63(7):546–554. doi: 10.1002/bjs.1800630713. [DOI] [PubMed] [Google Scholar]
- Hughes K. S., Simon R., Songhorabodi S., Adson M. A., Ilstrup D. M., Fortner J. G., Maclean B. J., Foster J. H., Daly J. M., Fitzherbert D. Resection of the liver for colorectal carcinoma metastases: a multi-institutional study of patterns of recurrence. Surgery. 1986 Aug;100(2):278–284. [PubMed] [Google Scholar]
- Karakousis C. P. Internal hemipelvectomy. Surg Gynecol Obstet. 1984 Mar;158(3):279–282. [PubMed] [Google Scholar]
- Karakousis C. P. Sacral resection with preservation of continence. Surg Gynecol Obstet. 1986 Sep;163(3):270–273. [PubMed] [Google Scholar]
- Karakousis C. P. The abdominoinguinal incision in limb salvage and resection of pelvic tumors. Cancer. 1984 Dec 1;54(11):2543–2548. doi: 10.1002/1097-0142(19841201)54:11<2543::aid-cncr2820541140>3.0.co;2-n. [DOI] [PubMed] [Google Scholar]
- Krook J. E., Moertel C. G., Gunderson L. L., Wieand H. S., Collins R. T., Beart R. W., Kubista T. P., Poon M. A., Meyers W. C., Mailliard J. A. Effective surgical adjuvant therapy for high-risk rectal carcinoma. N Engl J Med. 1991 Mar 14;324(11):709–715. doi: 10.1056/NEJM199103143241101. [DOI] [PubMed] [Google Scholar]
- Localio S. A., Eng K., Ranson J. H. Abdominosacral approach for retrorectal tumors. Ann Surg. 1980 May;191(5):555–560. doi: 10.1097/00000658-198005000-00006. [DOI] [PMC free article] [PubMed] [Google Scholar]
- MACCARTY C. S., WAUGH J. M., COVENTRY M. B., O'SULLIVAN D. C. Sacrococcygeal chordomas. Surg Gynecol Obstet. 1961 Nov;113:551–554. [PubMed] [Google Scholar]
- MacCARTY C. S., WAUGH J. M., MAYO C. W., COVENTRY M. B. The surgical treatment of presacral tumors: a combined problem. Proc Staff Meet Mayo Clin. 1952 Feb 13;27(4):73–84. [PubMed] [Google Scholar]
- Mazanet R., Antman K. H. Sarcomas of soft tissue and bone. Cancer. 1991 Aug 1;68(3):463–473. doi: 10.1002/1097-0142(19910801)68:3<463::aid-cncr2820680304>3.0.co;2-e. [DOI] [PubMed] [Google Scholar]
- Moertel C. G., Fleming T. R., Macdonald J. S., Haller D. G., Laurie J. A., Goodman P. J., Ungerleider J. S., Emerson W. A., Tormey D. C., Glick J. H. Levamisole and fluorouracil for adjuvant therapy of resected colon carcinoma. N Engl J Med. 1990 Feb 8;322(6):352–358. doi: 10.1056/NEJM199002083220602. [DOI] [PubMed] [Google Scholar]
- Pearlman N. W., Donohue R. E., Stiegmann G. V., Ahnen D. J., Sedlacek S. M., Braun T. J. Pelvic and sacropelvic exenteration for locally advanced or recurrent anorectal cancer. Arch Surg. 1987 May;122(5):537–541. doi: 10.1001/archsurg.1987.01400170043006. [DOI] [PubMed] [Google Scholar]
- Sundaresan N., Huvos A. G., Krol G., Lane J. M., Brennan M. Surgical treatment of spinal chordomas. Arch Surg. 1987 Dec;122(12):1479–1482. doi: 10.1001/archsurg.1987.01400240127024. [DOI] [PubMed] [Google Scholar]
- Takagi H., Morimoto T., Hara S., Suzuki R., Horio S. Seven cases of pelvic exenteration combined with sacral resection for locally recurrent rectal cancer. J Surg Oncol. 1986 Jul;32(3):184–188. doi: 10.1002/jso.2930320314. [DOI] [PubMed] [Google Scholar]
- Wanebo H. J., Futrell W., Constable W. Multimodality approach to surgical management of locally advanced epidermoid carcinoma of the anorectum. Cancer. 1981 Jun 15;47(12):2817–2826. doi: 10.1002/1097-0142(19810615)47:12<2817::aid-cncr2820471211>3.0.co;2-h. [DOI] [PubMed] [Google Scholar]
- Wanebo H. J., Gaker D. L., Whitehill R., Morgan R. F., Constable W. C. Pelvic recurrence of rectal cancer. Options for curative resection. Ann Surg. 1987 May;205(5):482–495. doi: 10.1097/00000658-198705000-00006. [DOI] [PMC free article] [PubMed] [Google Scholar]
- Wanebo H. J., Temple W. J., Popp M. B., Douvill C. E., Yablonski M. Combination regional therapy for extremity sarcoma. A tricenter study. Arch Surg. 1990 Mar;125(3):355–359. doi: 10.1001/archsurg.1990.01410150077014. [DOI] [PubMed] [Google Scholar]
- Wanebo H. J., Whitehill R., Gaker D., Wang G. J., Morgan R., Constable W. Composite pelvic resection. An approach to advanced pelvic cancer. Arch Surg. 1987 Dec;122(12):1401–1406. doi: 10.1001/archsurg.1987.01400240047008. [DOI] [PubMed] [Google Scholar]