844 Surgical Outcomes and Mortality for Patients Undergoing Total Pelvic Exenteration for Colorectal Cancer at One Year

Abstract Total pelvic exenteration (TPE) is undertaken at specialist centres for locally advanced rectal cancer. It carries significant morbidity and mortality. Research is often performed on small sample sizes resulting in limited data on surgical outcomes and mortality. A retrospective study conducted in St Thomas’ Hospital analysed colorectal cancer patients who underwent TPE’s from 2017-2021. Demographics and perioperative data including Clavien-Dindo (CD) score, 90 day and 1 year mortality was collected. Significant post-operative complications were considered for patients scoring >2 on CD scale. 124 patients were included in the study, mean age 63 (SD 10), (87% male; 13% female). TPE was undertaken for a primary rectal cancer in 77% and for recurrent disease in 23% of patients. Mean blood loss was 1688mls and median length of hospital stay was 18 days. Significant complications seen in 34% of patients. 69% patients had R0 resection, 25% R1 resection. Disease recurrence was significantly more prevalent in patients with R1 resections (p<0.0001). In total 42 patients experienced disease recurrence (60% metastatic, 40% local), mean disease free period was 405 days. 71% of relapsed patients had adjuvant therapy advised, with only 27% of advised patients going on to receive treatment. 1 year mortality shown to be 12% with 3 patients within 90 days of surgery. Patients experience a considerable risk of post-operative complications following TPE with over a third experiencing significant complications in the immediate post-operative period. Patients with R0 resections go on to have significantly less disease recurrence. Further research required into long term survival.