Management of recurrent pelvic tumors
P. N. Benotti, A. Bothe Jr, R. C. Eyre, B. Cady, W. V. McDermott and G. Steele
The management of regional tumor recurrence in the pelvis traditionally has
been a difficult problem for surgeons and oncologists. The only meaningful
therapy for these patients is a potentially curative re-resection. The
records and operative reports of 29 patients with regional pelvic tumor
recurrence treated between 1981 and 1986 were reviewed. The operative
procedures performed included three bowel resections, six abdominoperineal
resections, eight pelvic exenterations, eight resections of tumor
recurrence, and four conservative procedures. There was one operative death
in this group. Significant morbidity was noted in the group but was
clustered in a small number of patients operated on early in the series.
The median follow-up in this series was 13 months (range, two to 51
months). Nineteen (65%) of the patients are surviving at a median follow-up
of ten months (range, two to 51 months). The median survival (following
resection) in the ten patients (35%) who died was 18 months. In 15 (52%) of
the patients, a complete resection was performed. In this group, the
survival is 80% with a median follow-up of 11 months. Seven (37%) are
surviving with no evidence of disease. Palliation of symptoms occurred in
23 (79%) of the 29 patients. Radical resection of tumor recurrence in the
pelvis can be performed with acceptable mortality and complication rates.
This therapy should be considered for further clinical trials combining
surgical and adjuvant therapy in patients with regional pelvic tumor
recurrence.
