Exenterative surgery for recurrent gynaecological malignancies

Ang, Christine; Bryant, Andrew; Barton, Desmond P.J.; Pomel, Christophe; Naik, Raj

doi:10.1002/14651858.cd010449.pub2

Cited by 30 publications

(27 citation statements)

References 24 publications

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“…Despite a number of case series reporting favorable surgical outcomes of women after pelvic exenteration, a reliable assessment of the efficacy of this treatment approach is not possible due to heterogeneous study results, patient selection, and publication bias. A systematic review of the literature of the Cochrane Collaboration identified no randomized trial and concluded that there is no evidence to inform decisions about exenterative surgery for women with recurrent gynecologic malignancies [19]. Sardain et al [18] performed pelvic exenterations in 13 women with recurrent cervical cancer and 3 women with recurrent vaginal cancer.…”

Section: Treatment Of Local Pelvic Recurrencementioning

confidence: 99%

State-of-the-Art Treatment and Novel Agents in Local and Distant Recurrences of Cervical Cancer

Tempfer

Beckmann²

2016

Oncol Res Treat

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Depending on the stage at initial presentation, cervical cancer will recur in 25-61% of women. Typical manifestations of recurrent cervical cancer include the central pelvis and the pelvic side walls as well as retroperitoneal lymph node basins in the pelvis and the para-aortic region, and - more rarely - supraclavicular lymph nodes. There are no typical symptoms of recurrent cervical cancer. Women with suspected recurrence after cervical cancer based on gynecological examination or organ-specific symptoms must undergo imaging studies and - if technically feasible - biopsy with histological verification, especially in cases of distant metastases, in order to rule out a second primary. Radiotherapy-naïve women should be treated with salvage radiochemotherapy with curative intention. For women with previous radiotherapy, surgery in the form of hysterectomy, local resection, or pelvic exenteration is the treatment of choice. Pelvic exenteration can lead to cure in selected patients, but at the price of a high rate of complications and significant morbidity and mortality. If complete surgical resection is not feasible or if the woman is not a candidate for surgery, chemotherapy with palliative intent should be offered. Patients with recurrent disease outside the pelvis are candidates for systemic chemotherapy. Several agents have shown to be active in this situation, either in single-agent or combination regimens. Platinum-containing regimens have a superior efficacy over non-platinum regimens and bevacizumab may be added to chemotherapy.

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Section: Treatment Of Local Pelvic Recurrencementioning

confidence: 99%

State-of-the-Art Treatment and Novel Agents in Local and Distant Recurrences of Cervical Cancer

Tempfer

Beckmann²

2016

Oncol Res Treat

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“…Another more recent classification divides surgery into categories (supralevator, infralevator, and infralevator with vulvectomy) that are chosen based on the extent of the recurring disease. 54,55 Due to high rates of complications and mortality associated with this surgery, it should be reserved for much selected cases. It is especially suitable for pelvic recurrence after chemoradiation and when the surgeon anticipates the possibility of obtaining surgical margin, a prerequisite for cure.…”

Section: Special Situationsmentioning

confidence: 99%

“…54,55 As preoperative assessment, all the candidates for pelvic exenteration should undergo PET-CT to rule out distant disease. PET-CT is the imaging study with greater accuracy to detect cervical cancer recurrences.…”

Section: Special Situationsmentioning

confidence: 99%

“…Tumor size greater than 5 cm, recur-rence after less than two years of initial treatment, and histological type of squamous cell carcinoma (SCC) are associated with poor prognosis. 54,55 Regarding postoperative prognostic factors, worst outcome is found in the presence of positive meso-rectal lymph nodes, positive lymphovascular invasion, and margins compromised by tumor, with survival after two years around 10%. 54,55 resuMo Câncer de colo do útero: o que há de novo?…”

Section: Special Situationsmentioning

confidence: 99%

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Cervical cancer: what's new?

Sadalla

Andrade

Genta³

et al. 2015

Rev. Assoc. Med. Bras.

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Financial support: none Cervical cancer is the most common gynecological cancer in Brazil. Among women, it is the second most frequent, second only to breast cancer. It is the fourth leading cause of cancer death in the country, with estimated 15,590 new cases (2014) and 5,430 deaths (2013). In order to update information to improve outcomes, reduce morbidity and optimize the treatment of this cancer, this article will address the advancement of knowledge on cervical cancer. The topics covered include the role of surgery in different stages, treatment of locally advanced carcinomas, fertility preservation, the role of the sentinel lymph node technique, indications and techniques of radiotherapy and chemotherapy, and some special situations.

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“…A recent meta-analysis by Ang and colleagues of the Cochrane Gynecological Cancer Group revealed no evidence that would support decision-making about extensive surgery in cervical, endometrial, vaginal or vulvar malignancies due to the heterogeneity of the published literature [7].…”

Section: Introductionmentioning

confidence: 99%

Abdominoperineal Excisions in the Treatment Regimen for Advanced and Recurrent Vulvar Cancers—Analysis of a Single-Centre Experience

et al. 2015

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Vulva cancer is the fourth leading gynaecological malignancy, accounting for approximately 4 % of all gynaecological cancers. Surgery represents the treatment of choice, and cases of advanced or recurrent vulvar cancers are to date a major challenge to multidisciplinary teams. Abdominoperineal excision (APE) in combination with vulvectomy and inguinal lymphadenectomy is the only curative treatment option. Patients' files of all women with squamous cell carcinoma of the vulva who underwent abdominoperineal resection were retrospectively reviewed with special regards to technical challenges the general surgeon will face. Seven women were enrolled in this retrospective study with a median age of 71 years (range 56-79 years). In six patients, the pelvic floor after abdominoperineal excision could be closed by direct suture of the levator muscles. One woman underwent abdominoperineal resection with closure of the defect using a vertical rectus abdominis myocutaneous (VRAM) flap. All women underwent radical vulvectomy, in five patients in combination with bilateral inguinal lymph node dissection. Operation time was 377 min (range 130-505 min). The median overall survival after surgery was 27 months (range 4-84 months), with a calculated 5-year survival rate of 42 %. Women with negative lymph nodes revealed a longer survival time after surgery compared to women with lymph node metastases (15.5 vs. 72 months; p=0.09). Abdominoperineal excisions represent a powerful tool in the multidisciplinary treatment regimen of advanced or recurrent vulvar cancer. Reconstruction of the pelvic floor usually does not require myocutaneous flaps, even when facing large tumours. Despite high complication rates, radical surgery was a feasible treatment with long-term survival potential without mortality.

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Exenterative surgery for recurrent gynaecological malignancies

Cited by 30 publications

References 24 publications

State-of-the-Art Treatment and Novel Agents in Local and Distant Recurrences of Cervical Cancer

State-of-the-Art Treatment and Novel Agents in Local and Distant Recurrences of Cervical Cancer

Cervical cancer: what's new?

Abdominoperineal Excisions in the Treatment Regimen for Advanced and Recurrent Vulvar Cancers—Analysis of a Single-Centre Experience

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