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Pelvic exenteration, cytoreductive surgery, and hyperthermic intraperitoneal chemotherapy for peritoneal surface malignancy: experience and outcomes from an exenterative and peritonectomy unit

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Abstract

Purpose

Pelvic exenteration (PE) for locally advanced pelvic malignancy is well established, though high rates of morbidity and mortality exist. Such a complication profile has often deterred the surgical community from offering exenteration in combination with cytoreductive surgery (CRS) and hyperthermic intraperitoneal chemotherapy (HIPEC). We aimed to evaluate the perioperative outcomes following pelvic exenteration when combined with CRS and HIPEC for peritoneal surface malignancy (PSM) in a tertiary referral centre.

Methods

A review of a prospectively maintained PSM database from June 2015 to December 2020 at a tertiary referral institution was performed. Patients who underwent CRS, PE, and HIPEC were matched with patients who underwent PE alone. Primary endpoints were perioperative morbidity and mortality.

Results

From June 2015 to December 2020, 20 patients required PE as part of their CRS and HIPEC for PSM. The majority of patients were female (n = 16, 80%) with a median age of 52 (range 21–70). Colorectal cancer was the predominant pathology (n = 12, 60%). Median PCI was 11.5 (range 3–39). CC0 and R0 resections were achieved in all patients. CRS, PE, and HIPEC and PE-alone groups were well matched for clinicopathological variables. There was no difference in perioperative major morbidity (HIPEC: 30% vs PE: 15% p = 0.256) and mortality (HIPEC: 0 vs PE: 5% p = 0.311) between groups. Median follow-up was 17.5 months (range 7–68). Eight patients (40%) died from disease-related issues during the study period.

Conclusion

An aggressive surgical strategy with complete resection is feasible and safe in select patients with complex PSM involving the pelvis.

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Authors and Affiliations

  1. Department of Surgical Oncology, Peter MacCallum Cancer Centre, Melbourne, Australia

    Michael P. Flood, Peadar S. Waters, Mikael Soucisse, Robert Ramsay, Jacob J. McCormick, Satish Warrier & Alexander Heriot

  2. Sir Peter MacCallum Department of Oncology, University of Melbourne, Melbourne, Australia

    Michael P. Flood, Robert Ramsay, Michael Michael & Alexander Heriot

  3. Department of Medical Oncology, Peter MacCallum Cancer Centre, Melbourne, Australia

    Michael Michael

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  1. Michael P. Flood
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  2. Peadar S. Waters
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Correspondence to Michael P. Flood.

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All the authors have completed the Conflict of Interest Disclosure Form. This project satisfied Peter MacCallum Cancer Centre Ethics Committee and governance requirements and was granted ethical approval. Ethics approval number was 20/81R.

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Flood, M.P., Waters, P.S., Soucisse, M. et al. Pelvic exenteration, cytoreductive surgery, and hyperthermic intraperitoneal chemotherapy for peritoneal surface malignancy: experience and outcomes from an exenterative and peritonectomy unit. Langenbecks Arch Surg 406, 2807–2815 (2021). https://doi.org/10.1007/s00423-021-02323-5

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