Die Zielsetzung dieser Studie ist, die operativen Daten, die Folgen, die Komplikationen, die Langzeit-Nierenfunktion und das Überleben der pelvinen Exenteration retrospektiv zu analysieren. Es wurde eine Gegenüberstellung der Behandlungsergebnisse von inkontinenten mit kontinenten Harnableitungen durchgeführt, um das aufwendigere Verfahren der kontinenten Form kritisch betrachten zu können. Im Zeitraum von 1992 bis 2013 wurden 64 Exenterationen in der Klinik und Poliklinik für Urologie und Kinderurologie der Universität Würzburg aufgrund nicht-urothelialer Malignome durchgeführt. Das mediane Alter des gesamten Patientenkollektivs lag bei 65 Jahren. Hierunter befanden sich 50 vordere und 14 komplette Exenterationen. Eine Harnableitung durch Anlage der inkontinenten Form erfolgte in 39 und durch Anlage der kontinenten Form in 25 Fällen. Das breite Spektrum der Malignomentitäten des gesamten Kollektivs umfasste nicht-urotheliale Malignome der Zervix, des Uterus, der Vulva, der Prostata, der Harnblase und des Darms. Bei 24 Patienten (37,5%) gelang keine R0-Resektion, und bei 18 Patienten (28,1%) konnte ein Lymphknotenbefall nachgewiesen werden. Die Frühkomplikationsrate betrug 58,8%. In einem Zeitraum von 365 Tagen nach Exenteration lag der mediane Clavien-Wert bei 2 Punkten. Die perioperative Sterblichkeit lag bei 0% und die Tumorprogressionsrate bei 48,4%. Die Analyse des Überlebens ergab eine mediane Gesamtüberlebenszeit von 30 Monaten und eine 5-Jahres-Gesamtüberlebensrate von 42,7% über das gesamte Kollektiv hinweg. Die tumorspezifische 5-JahresÜberlebensrate betrug 55,6%, und eine R0-Resektion erwies sich als hochsignifikante Einflussgröße bezüglich der tumorspezifischen Überlebenszeit. Ein signifikanter Einfluss des Lymphknotenbefalls konnte nicht nachgewiesen werden. Der Einfluss der Komorbidität erwies sich als noch geringer. Die beiden Kollektive der Harnableitungsformen unterschieden sich signifikant in Komorbiditätsgrad, OP-Dauer, Hospitalisierungszeit und bezüglich der Harnableitungskomplikationen. Die Unterschiede der Komorbidität und der OP-Dauer waren sogar hochsignifikant. Dabei wiesen die Patienten mit Anlage eines kontinenten Verfahrens eine niedrigere Komorbidität, eine längere OP-Dauer, eine längere Hospitalisierungszeit und prozentual mehr Komplikationen bezüglich der Harnableitung auf. Weitere wichtige Parameter, in denen sich die Kollektive geringfügig unterschieden, waren das Alter und die ASA-Klassifikation. Das Kollektiv mit Anlage einer kontinenten Form war jünger und zeigte einen kleineren Wert bezüglich der präoperativen Risikoeinschätzung. Diese Parameter unterschieden sich jedoch nicht signifikant voneinander. Die inkontinente Harnableitung zeigte einen etwas höheren Anteil an weiter fortgeschrittenen Tumorstadien, und nur in diesem Kollektiv lagen präoperativ Metastasen vor. Bei den Früh- und Spätkomplikationen konnte kein nennenswerter Unterschied zwischen den beiden Kollektiven nachgewiesen werden. Nur um wenige Prozentpunkte war die Frühkomplikationsrate der inkontinenten Form (61,3%) höher als die der kontinenten (55,0%). Um den Schweregrad der Komplikationen miteinzubeziehen, wurde der mediane Clavien-Wert aller Komplikationen innerhalb von 365 Tagen erfasst. Er betrug in beiden Kollektiven 2 Punkte. Bei der Analyse des Überlebens zeigte sich, dass das Kollektiv mit Anlage einer kontinenten Form eine knapp über dem Signifikanzlevel höhere Überlebenswahrscheinlichkeit sowohl bezüglich der gesamten als auch der progressionsfreien Überlebenszeit im Vergleich zu den inkontinenten Verfahren aufwies. Allerdings waren die Unterschiede nicht signifikant und beide Gruppen heterogen bezüglich des Alters, der Komorbidität, den Tumorstadien und den Malignomentitäten. Die vorliegende Studie kommt zu dem Ergebnis, dass R0-Resektionen bei exenterativen Eingriffen eine essentielle Voraussetzung für das langfristige tumorspezifische Überleben darstellen. In beiden Kollektiven der verschiedenen Harnableitungen zeigte sich kein bedeutsamer Unterschied bezüglich der Komplikationen. Die geringere OP-Dauer und die geringere Anzahl an Komplikationen mit der Harnableitung sprechen für das inkontinente Verfahren. Die Überlebensraten zeigten bessere Ergebnisse für die kontinente Form, jedoch waren die Unterschiede nicht signifikant. Dennoch ist eine Bevorzugung des kontinenten Verfahrens, wenn es technisch möglich und onkologisch vertretbar ist, nach intensiver Beratung und unter Berücksichtigung des Zustandes sowie der Wünsche des Patienten durchaus gerechtfertigt. Aufgrund des nichtrandomisierten retrospektiven Charakters dieser Studie, die 2 heterogene Kollektive vergleicht, sollten idealerweise prospektiv angelegte Studien mit größerer Patientenanzahl in der Zukunft klären, ob die hier gefundenen Ergebnisse generelle Gültigkeit haben. / The objective of this study was to analyze the operative data, in order to determine the consequences, complications, renal function and survival rate of pelvic exenterations. The comparison of incontinent and continent urinary diversions took place to critically examine the complex procedure of the continent diversion. From 1992 to 2013, 64 exenterations were performed for non-urothelial cancers. The median age of the patients was 65 years. Incontinent urinary diversions were performed on 39 patients and continent urinary diversions on 25 patients. The wide range of different cancer types included non-urothelial cancers of the cervix, uterus, vulva, prostate, bladder and colon. The complication rate during the first 30 days was 58.8%. The median Clavien classification 365 days after the exenteration was 2 points, the perioperative mortality was 0%, and the tumor progression rate was 48.4%. Mortality revealed a median overall survival of 30 months and a 5-year overall survival rate of 42.7%. The cancer specific 5-year survival rate was 55.6% and R0 resection proved to be a significant influence on the cancer specific survival time. No significant influence of the lymph node status could be detected. No significant influence of comorbidities was detected either. The group of incontinent and continent urinary diversions differed significantly in comorbidities, operative time, hospital stay and complications stemming from the urinary diversion. The differences in comorbidity and operative time were highly significant. The patients with a continent urinary diversion showed lower comorbidity rates, longer operative time, longer hospital stay and more complications stemming from the urinary diversion. The mean age and the ASA classification were not significantly different. The patients with the continent urinary diversion were younger and showed a lower ASA classification. The patients, who received incontinent urinary diversions showed more advanced cancer stages. Metastases were only seen in the group receiving incontinent urinary diversion. No differences could be seen in early and late complications between the two groups. The complication rate within the first 30 days of the incontinent diversion group (61.3%) was only a few percentage points higher than that of the continent diversion group (55.0%). The Clavien classification of all complications were recorded to include the severity of the complications 365 days post procedure. Both groups showed 2 points. Analysis of mortality showed that the continent diversion group had a higher survival rate. In the overall and disease-free survival the difference was just above the significance level. This study concluded that R0 resections are an essential prerequisite for long-term cancer-specific survival in pelvic exenterations. Both the incontinent diversion group and continent diversion group showed no differences in complication rates. The incontinent urinary diversion group demonstrated a shorter operation time and fewer complications stemming from the urinary diversion. The continent urinary diversion group demonstrated a slightly better survival rate, but not a significant one. The continent urinary diversion procedure can be justified through intense review with the patient, if it is technically possible and acceptable from an oncological perspective. To determine if these results are generally valid, prospective studies with a larger number of patients should be done.

A exenteração pélvica é método efetivo no tratamento de tumores pélvicos localmente avançados. As cirurgias mais conservadoras, com preservação funcional dos esfíncteres e reconstrução continente dos tratos intestinal e urinário podem melhorar a qualidade de vida e estimular os pacientes a aceitar a cirurgia. O objetivo deste estudo foi avaliar os resultados da exenteração pélvica no tratamento dos tumores pélvicos localmente avançados em relação à preservação dos esfíncteres e fatores associados ao prognóstico. Analisou-se retrospectivamente os fatores relacionados à preservação dos esfíncteres bem como os fatores associados ao prognóstico em pacientes submetidos à exenteração pélvica. Dos 96 pacientes submetidos à exenteração pélvica, preservou-se pelo menos um dos esfíncteres em 36 (37,5%). Na década de 1990 a taxa de preservação esfincteriana foi significativamente maior do que na década de 1980 (47,6 versus 18,2%) (p = 0,005). As variáveis independentemente relacionadas à preservação de esfíncter foram tratamento realizado na década de 1990 e tumor de origem coloproctológica. A taxa de complicação pós-operatória não foi influenciada pela preservação dos esfíncteres (p = 0,276). Não se observou diferença estatisticamente significativa nas taxas de morbidade entre as décadas de 1990 e 1980 (55,6% versus 75,8%; p = 0,075). Na década de 1990 houve redução da taxa de mortalidade pós-operatória em relação à década de 1980 (9,5% versus 27,3%; p = 0,023). Em nove pacientes, as margens de ressecção estavam microscopicamente comprometidas (R1) e, em cinco macroscopicamente comprometidas (R2). As margens de ressecção não foram influenciadas pelo tipo de cirurgia (p = 0,104), nem pela preservação dos esfíncteres (p = 0,881). A taxa de sobrevida livre de doença em cinco anos foi de 40,5%. Observou-se associação da recorrência com perda de peso (p = 0,006), índice de Karnofsky (p = 0,035) e a topografia do tumor (p = 0,027). No modelo multivariado, a perda de peso e os tumores de origem ginecológica foram as variáveis independentes para recorrência. Pacientes portadores de tumores ginecológicos ou com perda de peso foram considerados de alto risco para recorrência e os pacientes portadores de tumores não ginecológicos e sem perda de peso, de baixo risco. O grupo de alto risco apresentou chance de recorrência cerca de sete vezes maior do que o de baixo risco. A sobrevida livre de doença em 5 anos para os grupos de baixo e de alto risco foram, respectivamente, de 78,0% e 21,2%. As variáveis associadas ao óbito foram a idade superior a 60 anos (p = 0,007), a perda de peso (p = 0,004), radioterapia pré-operatória (p = 0,043), década de trata mento (p = 0,050) e preservação de esfíncter (p=0,026). No modelo multivariado as variáveis associadas ao óbito foram tratamento realizado na década de 1980, a idade superior a 60 anos e a perda de peso. Com os resultados deste estudo podemos concluir que houve aumento significante da preservação dos esfíncteres na década de 1990 sem aumento da freqüência de margens cirúrgicas comprometidas nem prejuízo na sobrevida dos pacientes submetidos à exenteração pélvica com preservação dos esfíncteres / Pelvic exenteration (PE) is an effective method for treating locally advanced pelvic tumors. More conservative surgeries, preserving sphincters and continent reconstruction of the intestinal and urinary tract, which could contribute to a better quality of life and encourage patients to accept this procedure. The objective of this study was to evaluate the results of PE in the treatment of locally advanced pelvic tumors, mainly considering sphincter preservation and factors associated to the prognosis. Between 1980 and 2000, 96 PE were performed. Factors related to sphincter preservation as well as factors associated to prognosis were respectively analyzed. Of the 96 patients treated with pelvic exenteration, at least one sphincter in 36 patients was preserved (37.5%). In the 1990\'s, the sphincter preservation rate was significantly higher than in the 1980\'s (47.6 vs. 18.2 %) (p = 0.005). Independent variables related to the sphincter preservation were decades from the realization of surgery 1990\'s and coloproctological tumors. The postoperative complication rate was not influenced by sphincter preservation (p = 0.276). Statistically, there was no differentiation between the morbidity rates during the 1980\'s and 1990\'s (55.6% versus 75.8%, p = 0.075). In the 1990\'s, there was a reduction in the post-operative mortality rate compared to the 1980s\' rate (9.5% versus 27.3%; p = 0.023). In nine patients, the resection margins were compromised microscopically (R1) and in five patients, macroscopically compromised (R2). The resection margins were not influenced by the type of surgery (p = 0.104), nor by the preservation of sphincters (p = 0.881). Disease free survival at five years was 40.5%. Among the clinical variables, there was an association between recurrence and weight loss (p = 0.006) and the Karnofsky index (p = 0.035). The topography of the tumor showed links with recurrence (p = 0.027). In the multivariable model, the independent variables related to recurrence were weight loss and gynecological tumors. Patients with gynecological tumors or with weight loss were considered high risk for recurrence, while patients with no gynecological tumors and without weight loss were considered low risk. The high risk group showed 7 times more chance of recurrence than the low risk group. Survival rates of patients, who remained disease-free, after 5 years, for the low and high risk group were 78.0% and 21.2% respectively. Death was linked to ages over 60 (p = 0.007), weight loss (p = 0.004), pre-surgery radiotherapy (p = 0.043), decades from the realization of surgery (p = 0.050) and the sphincter preservation (p = 0.026). The independent variables related to death were treatments in the 1980\'s, ages over 60 and weight loss. Taking into account the results in this research, we conclude that there was a significant increase of sphincter preservation during the 1990\'s and neither the type of surgery nor sphincter preservation were associated to a higher number of surgeries with compromised margins allows pelvic exenteration to be performed with sphincter preservation, without harming survival rates

O carcinoma basocelular (CBC) é uma neoplasia cutânea maligna de baixo potencial metastatizante, originada das células da camada basal da epiderme. Sua importância clínico-epidemiológica pode ser constatada pelo fato de constituir a neoplasia maligna mais comum na espécie humana, cujo principal fator etiológico é a exposição à radiação ultravioleta. Apesar da baixa incidência de metástases, a neoplasia pode adotar um comportamento localmente agressivo, com comprometimento de estruturas profundas e de forte apelo estético, como ocorre na região periocular. Uma das complicações advindas de sua infiltração neste sítio anatômico consiste na invasão de tecidos orbitários cujo tratamento é a exenteração, conduta mutiladora que consiste na retirada do globo ocular e das partes moles da órbita acometida. O objetivo deste estudo foi avaliar os casos de CBC com invasão orbitária que foram submetidos à exenteração no Hospital de Clínicas de Ribeirão Preto, no período de 1992 a 2012, para a possível identificação de fatores clínicos e morfológicos que possam predizer uma evolução desfavorável da neoplasia. Foi realizada uma coleta de dados clínicos, epidemiológicos e histopatológicos dos casos submetidos à exenteração a partir dos prontuários médicos dos pacientes. As lâminas referentes aos exames anátomo-patológicos foram revistas e foi realizado estudo imuno-histoquimico para os marcadores p53, bcl-2, actina de músculo liso e metaloproteinase-1. O grupo controle foi composto por pacientes com diagnóstico da neoplasia em topografia periocular, sem sinais de invasão orbitária. Para os casos com invasão orbitária o número de casos positivos marcados para p53 (0,21) e para actina de músculo liso (0,21) foi significantemente menor que o número de casos positivos para bcl-2 (0,63) e MMP-1 (0,58) (p= 0,0331). Entretanto, o número de casos positivos para bcl-2 (0,63) foi significantemente maior que o número de casos marcados por MMP-1 (0,58) (p=0,0126). Para os tumores sem invasão orbitária, o número de casos positivos para p53 (0,31) e actina (0,31) foi significantemente menor que o número de casos positivos para bcl-2 (0,63) eMMP-1 (0,50) (p=0,0273). Os resultados indicam que a invasão orbitaria por carcinoma basocelular palpebral ocorre com maior frequência no sexo masculino, em pacientes com longa história clínica de múltiplas lesões e submetidos a múltiplos procedimentos. Além disso, os marcadores estudados aparentemente não podem predizer um comportamento mais agressivo do tumor. / Basal cell carcinoma (BCC) is a malignant skin cancer of low metastasizing potential originated from the basal cells of the epidermis. Its clinical and epidemiological importance is evidenced by the fact that it is the most common malignancy in humans and it has as the main etiological factor the exposure to ultraviolet radiation. Despite the low incidence of metastases, the cancer can adopt a locally aggressive behavior with involvement of deep structures and it can have a strong aesthetic appeal, as in the periocular region. One of the complications arising from its infiltration in this anatomical site consists of orbital tissue invasion whose treatment is exenteration, a mutilating procedure consisting of the removal of the eyeball and the soft tissue of the affected orbit. The aim of this study was to evaluate the cases of BCC with orbital invasion that underwent exenteration at the Clinics Hospital of Ribeirão Preto Medical School, University of Sao Paulo, from 1992 through 2012, for possible identification of clinical and morphological factors that can predict an unfavorable evolution of the tumor. The clinical data were obtained from the patients\' charts and we have reviewed all the slides from exenteration specimens and performed immunohistochemical studies with p53, bcl-2, smooth muscle actin and metalloproteinase-1(MMP-1). The control group consisted of age-matched patients with eyelid basal cell carcinomas without orbital invasion. For cases with orbital invasion the number of positive cases labeled for p53 (0.21) and actin (0.21) was significantly lower than the number of positive cases for bcl-2 (0.63) and MMP -1 (0.58) (p = 0.0331). However, the number of positive cases for bcl-2 (0.63) was significantly greater than the proportion of positive cases for MMP-1 (0.58) (p = 0.0126). For cases without orbital invasion the number of positive cases for p53 (0.31) and actin (0.31) was significantly lower than the number of positive cases for bcl-2 (0.63) and MMP-1 (0.50) (p = 0.0273), even though the number of positive cases marked for MMP-1 (0.50) was not significantly different from number of positive cases for bcl-2 (0.63) (p = 0.059). The results indicate that orbital invasion of basal cell carcinoma of the eyelid was more frequent in male sex and that the patients have usually a long history of multiple lesions and were submitted to several procedures. In addition, our results suggest these markers can not predict an aggressive behavior for basal cell carcinomas of the periocular region.

O carcinoma basocelular (CBC) é uma neoplasia cutânea maligna de baixo potencial metastatizante, originada das células da camada basal da epiderme. Sua importância clínico-epidemiológica pode ser constatada pelo fato de constituir a neoplasia maligna mais comum na espécie humana, cujo principal fator etiológico é a exposição à radiação ultravioleta. Apesar da baixa incidência de metástases, a neoplasia pode adotar um comportamento localmente agressivo, com comprometimento de estruturas profundas e de forte apelo estético, como ocorre na região periocular. Uma das complicações advindas de sua infiltração neste sítio anatômico consiste na invasão de tecidos orbitários cujo tratamento é a exenteração, conduta mutiladora que consiste na retirada do globo ocular e das partes moles da órbita acometida. O objetivo deste estudo foi avaliar os casos de CBC com invasão orbitária que foram submetidos à exenteração no Hospital de Clínicas de Ribeirão Preto, no período de 1992 a 2012, para a possível identificação de fatores clínicos e morfológicos que possam predizer uma evolução desfavorável da neoplasia. Foi realizada uma coleta de dados clínicos, epidemiológicos e histopatológicos dos casos submetidos à exenteração a partir dos prontuários médicos dos pacientes. As lâminas referentes aos exames anátomo-patológicos foram revistas e foi realizado estudo imuno-histoquimico para os marcadores p53, bcl-2, actina de músculo liso e metaloproteinase-1. O grupo controle foi composto por pacientes com diagnóstico da neoplasia em topografia periocular, sem sinais de invasão orbitária. Para os casos com invasão orbitária o número de casos positivos marcados para p53 (0,21) e para actina de músculo liso (0,21) foi significantemente menor que o número de casos positivos para bcl-2 (0,63) e MMP-1 (0,58) (p= 0,0331). Entretanto, o número de casos positivos para bcl-2 (0,63) foi significantemente maior que o número de casos marcados por MMP-1 (0,58) (p=0,0126). Para os tumores sem invasão orbitária, o número de casos positivos para p53 (0,31) e actina (0,31) foi significantemente menor que o número de casos positivos para bcl-2 (0,63) eMMP-1 (0,50) (p=0,0273). Os resultados indicam que a invasão orbitaria por carcinoma basocelular palpebral ocorre com maior frequência no sexo masculino, em pacientes com longa história clínica de múltiplas lesões e submetidos a múltiplos procedimentos. Além disso, os marcadores estudados aparentemente não podem predizer um comportamento mais agressivo do tumor. / Basal cell carcinoma (BCC) is a malignant skin cancer of low metastasizing potential originated from the basal cells of the epidermis. Its clinical and epidemiological importance is evidenced by the fact that it is the most common malignancy in humans and it has as the main etiological factor the exposure to ultraviolet radiation. Despite the low incidence of metastases, the cancer can adopt a locally aggressive behavior with involvement of deep structures and it can have a strong aesthetic appeal, as in the periocular region. One of the complications arising from its infiltration in this anatomical site consists of orbital tissue invasion whose treatment is exenteration, a mutilating procedure consisting of the removal of the eyeball and the soft tissue of the affected orbit. The aim of this study was to evaluate the cases of BCC with orbital invasion that underwent exenteration at the Clinics Hospital of Ribeirão Preto Medical School, University of Sao Paulo, from 1992 through 2012, for possible identification of clinical and morphological factors that can predict an unfavorable evolution of the tumor. The clinical data were obtained from the patients\' charts and we have reviewed all the slides from exenteration specimens and performed immunohistochemical studies with p53, bcl-2, smooth muscle actin and metalloproteinase-1(MMP-1). The control group consisted of age-matched patients with eyelid basal cell carcinomas without orbital invasion. For cases with orbital invasion the number of positive cases labeled for p53 (0.21) and actin (0.21) was significantly lower than the number of positive cases for bcl-2 (0.63) and MMP -1 (0.58) (p = 0.0331). However, the number of positive cases for bcl-2 (0.63) was significantly greater than the proportion of positive cases for MMP-1 (0.58) (p = 0.0126). For cases without orbital invasion the number of positive cases for p53 (0.31) and actin (0.31) was significantly lower than the number of positive cases for bcl-2 (0.63) and MMP-1 (0.50) (p = 0.0273), even though the number of positive cases marked for MMP-1 (0.50) was not significantly different from number of positive cases for bcl-2 (0.63) (p = 0.059). The results indicate that orbital invasion of basal cell carcinoma of the eyelid was more frequent in male sex and that the patients have usually a long history of multiple lesions and were submitted to several procedures. In addition, our results suggest these markers can not predict an aggressive behavior for basal cell carcinomas of the periocular region.

A exenteração pélvica é método efetivo no tratamento de tumores pélvicos localmente avançados. As cirurgias mais conservadoras, com preservação funcional dos esfíncteres e reconstrução continente dos tratos intestinal e urinário podem melhorar a qualidade de vida e estimular os pacientes a aceitar a cirurgia. O objetivo deste estudo foi avaliar os resultados da exenteração pélvica no tratamento dos tumores pélvicos localmente avançados em relação à preservação dos esfíncteres e fatores associados ao prognóstico. Analisou-se retrospectivamente os fatores relacionados à preservação dos esfíncteres bem como os fatores associados ao prognóstico em pacientes submetidos à exenteração pélvica. Dos 96 pacientes submetidos à exenteração pélvica, preservou-se pelo menos um dos esfíncteres em 36 (37,5%). Na década de 1990 a taxa de preservação esfincteriana foi significativamente maior do que na década de 1980 (47,6 versus 18,2%) (p = 0,005). As variáveis independentemente relacionadas à preservação de esfíncter foram tratamento realizado na década de 1990 e tumor de origem coloproctológica. A taxa de complicação pós-operatória não foi influenciada pela preservação dos esfíncteres (p = 0,276). Não se observou diferença estatisticamente significativa nas taxas de morbidade entre as décadas de 1990 e 1980 (55,6% versus 75,8%; p = 0,075). Na década de 1990 houve redução da taxa de mortalidade pós-operatória em relação à década de 1980 (9,5% versus 27,3%; p = 0,023). Em nove pacientes, as margens de ressecção estavam microscopicamente comprometidas (R1) e, em cinco macroscopicamente comprometidas (R2). As margens de ressecção não foram influenciadas pelo tipo de cirurgia (p = 0,104), nem pela preservação dos esfíncteres (p = 0,881). A taxa de sobrevida livre de doença em cinco anos foi de 40,5%. Observou-se associação da recorrência com perda de peso (p = 0,006), índice de Karnofsky (p = 0,035) e a topografia do tumor (p = 0,027). No modelo multivariado, a perda de peso e os tumores de origem ginecológica foram as variáveis independentes para recorrência. Pacientes portadores de tumores ginecológicos ou com perda de peso foram considerados de alto risco para recorrência e os pacientes portadores de tumores não ginecológicos e sem perda de peso, de baixo risco. O grupo de alto risco apresentou chance de recorrência cerca de sete vezes maior do que o de baixo risco. A sobrevida livre de doença em 5 anos para os grupos de baixo e de alto risco foram, respectivamente, de 78,0% e 21,2%. As variáveis associadas ao óbito foram a idade superior a 60 anos (p = 0,007), a perda de peso (p = 0,004), radioterapia pré-operatória (p = 0,043), década de trata mento (p = 0,050) e preservação de esfíncter (p=0,026). No modelo multivariado as variáveis associadas ao óbito foram tratamento realizado na década de 1980, a idade superior a 60 anos e a perda de peso. Com os resultados deste estudo podemos concluir que houve aumento significante da preservação dos esfíncteres na década de 1990 sem aumento da freqüência de margens cirúrgicas comprometidas nem prejuízo na sobrevida dos pacientes submetidos à exenteração pélvica com preservação dos esfíncteres / Pelvic exenteration (PE) is an effective method for treating locally advanced pelvic tumors. More conservative surgeries, preserving sphincters and continent reconstruction of the intestinal and urinary tract, which could contribute to a better quality of life and encourage patients to accept this procedure. The objective of this study was to evaluate the results of PE in the treatment of locally advanced pelvic tumors, mainly considering sphincter preservation and factors associated to the prognosis. Between 1980 and 2000, 96 PE were performed. Factors related to sphincter preservation as well as factors associated to prognosis were respectively analyzed. Of the 96 patients treated with pelvic exenteration, at least one sphincter in 36 patients was preserved (37.5%). In the 1990\'s, the sphincter preservation rate was significantly higher than in the 1980\'s (47.6 vs. 18.2 %) (p = 0.005). Independent variables related to the sphincter preservation were decades from the realization of surgery 1990\'s and coloproctological tumors. The postoperative complication rate was not influenced by sphincter preservation (p = 0.276). Statistically, there was no differentiation between the morbidity rates during the 1980\'s and 1990\'s (55.6% versus 75.8%, p = 0.075). In the 1990\'s, there was a reduction in the post-operative mortality rate compared to the 1980s\' rate (9.5% versus 27.3%; p = 0.023). In nine patients, the resection margins were compromised microscopically (R1) and in five patients, macroscopically compromised (R2). The resection margins were not influenced by the type of surgery (p = 0.104), nor by the preservation of sphincters (p = 0.881). Disease free survival at five years was 40.5%. Among the clinical variables, there was an association between recurrence and weight loss (p = 0.006) and the Karnofsky index (p = 0.035). The topography of the tumor showed links with recurrence (p = 0.027). In the multivariable model, the independent variables related to recurrence were weight loss and gynecological tumors. Patients with gynecological tumors or with weight loss were considered high risk for recurrence, while patients with no gynecological tumors and without weight loss were considered low risk. The high risk group showed 7 times more chance of recurrence than the low risk group. Survival rates of patients, who remained disease-free, after 5 years, for the low and high risk group were 78.0% and 21.2% respectively. Death was linked to ages over 60 (p = 0.007), weight loss (p = 0.004), pre-surgery radiotherapy (p = 0.043), decades from the realization of surgery (p = 0.050) and the sphincter preservation (p = 0.026). The independent variables related to death were treatments in the 1980\'s, ages over 60 and weight loss. Taking into account the results in this research, we conclude that there was a significant increase of sphincter preservation during the 1990\'s and neither the type of surgery nor sphincter preservation were associated to a higher number of surgeries with compromised margins allows pelvic exenteration to be performed with sphincter preservation, without harming survival rates