Search

Background Most published data on pelvic exenteration comes from high-volume quaternary units, with limited data available from outside of this setting. This study reports outcomes of selective pelvic exenteration performed in a low-volume tertiary unit with multidisciplinary support. Methods A retrospective review of consecutive patients who underwent pelvic exenteration surgery for rectal/anal carcinoma, or gynaecological malignancy at Royal Adelaide Hospital between June 2008 and September 2018. Descriptive statistics and Kaplan-Meier analysis of 5-year disease-free and overall survival for patients treated with curative intent were performed. Results A total of 54 patients who underwent pelvic exenteration were included. Most patients presented with primary rectal adenocarcinoma, and posterior and total pelvic exenterations were the most common operations performed (>90%). Median total operating time was 323 min, median hospital stay was 15 days, and the readmission rate was 14.8%. The overall complication rate (per patient) was 70.4%, and the re-intervention rate was 20.4%. Thirteen percent of patients required intensive care unit-admission, and there was one postoperative death (1.9%). R0 resection margins were achieved in 81.5% of patients, with R1 and R2 margins in 13.0 and 5.6% of patients, respectively. Estimated 5-year disease-free survival was 38.8%, and 5-year overall survival was 65.7%. Conclusion Short- and long-term outcomes of selective pelvic exenteration surgery are acceptable in a low-volume specialized tertiary setting with suitable multidisciplinary expertise. If the required expertise is not readily available, then outside referral is recommended.

When two animals compete directly for an indivisible resource, the outcome may be influenced by differences in the contestants' intrinsic contest abilities and prior owner status, collectively termed ‘resource-holding potential’, and also by any difference in the values that contestants place on the resource. Using owner–intruder contests and owner–owner contests between females of the parasitoid wasp Goniozus nephantidis, we investigated the influence of resource value asymmetries generated by differences in contestant age and by the size of the host resource, while taking resource-holding potentials into account. When owners and intruders competed, intruder success increased with both intruder age and relative body size, suggesting that larger females had greater contest ability and that older intruders valued more greatly the opportunity to obtain a host. The size of the host did not influence the outcome of owner–intruder contests but in owner–owner contests, in which asymmetries in ownership status were absent, both larger females and owners of the larger, more valued, hosts were advantaged. Overall, studies of G. nephantidis show that asymmetries in both resource-holding potentials and resource values interact to influence contest outcomes. Despite a large literature on animal contests, there have been few studies that have evaluated these influences both simultaneously and separately.