Radical cytoreductive surgery and hyperthermic intraperitoneal chemotherapy plus total pelvic exenteration in patient with peritoneal metastasis and advanced pelvic desease

OjectiveSome patients with peritoneal metastasis treated with cytoreductive surgery (CRS) + hyperthermic intraperitoneal chemotherapy (HIPEC) present advanced tumor in pelvis which requied a total pelvic exenteration (TPE) for completing the radicality of surgery. This study aims to present the criteria used for the indication of CRS+TPE+HIPEC and the surgical techniques and modalities and, especially, reconstructive of TPE aimed at avoiding functional stomata.MethodsThe information comes from a prospective database that includes 1,172 patients with peritoneal metastases underwent 1,314 procedures of CRS+HIPEC during the period September 2006 to January 2021. We identified 14 patients underwent TPE and function reconstruction without the practice of any kind of stomata.ResultsIn all patients, completeness of cytoreduction (CC)-0 was achieved by applying peritonectomy procedures (PP) and radial margins R0 in the TPE. There were no complications in digestive anastomosis. In 5 patients, urinary leakage was observed in the postoperative period (3 cases did not require invasive reparing measures, one patient accepted a nephrostomy, and one patient was reoperated). There were no postoperative deaths within 90 days.ConclusionsIn the context of CRS+HIPEC, TPE should not be absolutly excluded. The concentration of oncological pathologists and surgical team in highly specialized centers allows to improve the efficacy and safety of the combination of CRS+TPE+HIPEC and the possibility of offering improvements in the recovery and quality of life of these patients. The CRS+TPE+HIPEC combination in patients with peritoneal metastases and advanced pelvic disease still requires further studies.