• Kirk K S Austin, Andrew J Herd, Michael J Solomon, Ken Ly, and Peter J Lee.
• 1 Department of Colorectal Surgery, Royal Prince Alfred Hospital, Camperdown, New South Wales, Australia 2 Surgical Outcomes Research Centre (SOuRCe), Royal Prince Alfred Hospital, Camperdown, New South Wales, Australia 3 Institute of Academic Surgery at Royal Prince Alfred Hospital, Camperdown, New South Wales, Australia 4 Discipline of Surgery, University of Sydney, New South Wales, Australia.
• Dis. Colon Rectum. 2016 Sep 1; 59 (9): 831-5.

IntroductionNeoplasms infiltrating the pubic bone have until recently been considered a contraindication to surgery. Paucity of existing published data in regard to surgical techniques and outcomes exist.ObjectiveThis study aims to address outcomes of our recently published technique for en bloc composite pubic bone excision during pelvic exenteration.DesignA prospective database was reviewed to identify patients who underwent a partial or complete pubic bone composite excision over a 12-year period.SettingsThis study was conducted at a tertiary level exenteration unit.Main Outcome MeasuresPrimary outcomes measured were resection margin and survival. Secondary outcomes included patient and operative demographics, type of cancer, extent of pubic bone excision, morbidity, and 30-day mortality.ResultsTwenty-nine of over 500 patients undergoing exenterations (mean age, 57.9; 20 males) underwent en bloc complete (11 patients) or partial (18 patients) composite pubic bone excision. Twenty-two patients (76%) underwent resection for recurrent as opposed to advanced primary malignant disease of which rectal adenocarcinoma was the most common followed by squamous-cell carcinoma. The median operating time was 10.5 (range, 6-15) hours, and median blood loss was 2971 (range, 300-8600) mL. Seventeen (59%) patients had a concurrent sacrectomy performed mainly S3 and below. A total cystectomy was performed in 26 patients (90%). Fifteen of 20 male patients (75%) had a perineal urethrectomy. A clear (R0) resection margin was achieved in 22 patients (76%) with a 5-year overall survival of 53% after a median follow-up of 3.2 years (r = 1.4-12.3 years). There was no 30-day mortality. Seventy percent of patients experienced morbidity with a pelvic collection the most common.LimitationsThis study was limited because it was a retrospective review, it occurred at a single site, and it used a small heterogeneous sample.ConclusionWithin the realm of evolving exenteration surgery, en bloc composite pubic bone excision offers results comparable to central, lateral, and posterior compartment excisions, and, as such, is a reasonable strategy in the management of neoplasms infiltrating the pubic bone.

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