Pelvic exenterations for gynecological malignancies: twenty-year experience at Roswell Park Cancer Institute

Abstract

The objective of this study is to review the experience with pelvic exenterations for gynecological malignancies at our cancer institute. Charts of 48 women who underwent a pelvic exenteration between January 1980 and December 1999 were reviewed, and several outcomes were analyzed. Majority of patients had received prior radiation therapy. The median survival was 35 months, and the disease-free survival was 32 months. Mortality from the procedure was 4.2%. Early and late postoperative complication rates were 27% and 75%, respectively. Recurrence rate was 60%. Eight patients received intraoperative radiation. Median survival in this group was 11.3 vs 35 months (P = 0.003). Univariate analysis failed to show an association between type of pelvic exenteration, type of fecal and urinary diversion, outcome, need for reoperation, and recurrence.Contemporary pelvic exenterations are associated with a low mortality and a potential for long-term survival in a subset of patients who historically have been given a poor prognosis. In patients with recurrent gynecological cancer confined centrally to the pelvis, pelvic exenteration still remains the choice of therapy as response to chemotherapy to a centrally recurrent tumor in radiated area continues to be poor. Intraoperative radiation in select few patients needs to be further studied.

Exenterations 60 Years After First Description

“…Most oncologic centers in both countries do not define an age threshold. 9,10,12,13,15 The impact of the tumor size of the recurrent tumor is discussed controversially. 2,10,13,16 Tumor-involved para-aortic lymph nodes or peritoneal tumor is generally seen as a contraindication.…”

“…2,10,13,16 Tumor-involved para-aortic lymph nodes or peritoneal tumor is generally seen as a contraindication. 7,11,12,16,24 However, 21% of German institutions continue surgery despite the presence of distant metastasis, and 86% continue in patients with positive intraperitoneal cytology.…”

Oncological outcome of surgical management in patients with recurrent uterine cancer—a multicenter retrospective cohort study—CEEGOG EX01 Trial

“…Although some smaller studies did not find a prognostic significance of the progression-free interval from the primary treatment in patients after pelvic exenteration,29 most authors reported a substantially better prognosis in cases with a long interval from the initial treatment 3 30. Marnitz reported a 17% 5-year survival in patients who experienced recurrence in <2 years after the initial treatment, 28% for patients with disease recurring between 2 and 5 years, and 83% if recurrence was later than 5 years 3.…”

Pelvic Exenteration for Recurrent Gynecologic Malignancy

“…17,19 The procedure can be classified as supralevatory or infralevatory depending on the resection lines in relation to the levator ani muscles. 1 An anterior PE generates a need for urinary deviation, and an infralevatory excision including the removal of the anal canal requires a permanent colostomy.…”

“…However, improved patient selection, surgical techniques, and perioperative care have resulted in decreased morbidity and potential for long-term survival. 17,21 The objective of this study was to review a singleinstitution experience of PE for patients with recurrent gynecologic malignancy over a decade, in terms of patient and surgical characteristics, complications, recurrences, and survival.…”