Metastases of the pelvis: does resection improve survival?

Limited data are available to compare the outcome of wide en bloc resection and curettage for pelvic metastases. Previous studies have reported that curettage is associated with high mortality and decreased survival compared to wide resection and have justified consideration of a radical surgical approach to achieve pain palliation and tumor control. In this study, we aimed to evaluate the role of curettage/marginal resection compared to wide en bloc resection for patients with pelvic metastases. The hypothesis was that wide resection does not improve survival even in patients with solitary pelvic metastases. Between 1985 and 2009, twenty-one patients with pelvic metastases were treated with wide resection (12 patients) and curettage/marginal resection (9 patients) and adjuvants. Sixteen patients had solitary pelvic metastases. At a mean of 28 months (range, 2-152 months), we found no difference in survival to death or local recurrence with wide en bloc resection compared to curettage or marginal resection, even in patients with solitary pelvic metastases. The overall survival to death and local recurrence was 30% and 47% at 60 months, respectively. Survival to death of patients treated with wide resection was 18% at 60 months compared to 62% at 60 months of patients treated with curettage/marginal resection; no difference in survival to death between wide resection and curettage/marginal resection was observed even in patients with solitary pelvic metastases. Survival to local recurrence of patients treated with wide en bloc resection was 67% at 36 months compared to 26% at 36 months of patients treated with curettage/marginal resection; this was also not statistically significant. One patient treated with wide resection for a solitary pelvic metastasis had a postoperative complication.