Total pelvic clearance for advanced pelvic malignancy

Objective:  Advanced pelvic tumours require multidisciplinary care to improve outcome. This is an audit of one specialist unit's experience.
Method:  Consecutive patients referred from 2001 to 2005 for consideration of pelvic clearance were evaluated by retrospective review.
Results:  Of 100 patients assessed, 55 were considered unsuitable for surgery. Exclusions included unresectable pelvic side-wall disease (25), widespread disease (23) and severe co-morbidity (7). Forty-five patients were operated on; 22 had locally advanced disease, 14 had recurrence and nine had residual disease following previous surgery. The primary cancers were colorectal in 24, gynaecological in 10 and urogenital in 10; one patient had non-neoplastic disease. Preoperatively 39 (87%) had examination under anaesthetic (87%) and all had MR and CT imaging. Neoadjuvant radiotherapy and chemotherapy was given in 27 and 18 patients respectively. Following resection by a multi-speciality team, surgery was considered curative in 40 (90%) of cases as judged by a histologically negative margin. All patients received level 2 care postoperatively with only two requiring level 3 care. There was no 30-day mortality but there were 17 complications treated conservatively and five that required surgery.
Conclusion:  Advanced pelvic tumours require careful multidisciplinary assessment and treatment. This study shows that this can be performed safely with high levels of histological clearance of tumour.