Analysis of long-term outcomes in 44 patients following pelvic exenteration due to cervical cancer

Abstract

Background: Pelvic exenteration (PE) may be associated with prolonged overall survival (OS) in selected patients with advanced or recurrent cervical cancer. However, the factors related to improved survival following PE are not clearly defined. The aim of this study was to perform a retrospective analysis of OS rates in a group of patients undergoing PE in order to identify the factors related to improved long-term outcomes. Methods: Our study group consisted of 44 patients, including 21 squamous cell cancer (SCC) patients, 22 patients with adenocarcinomas (AC) of the cervix, and one patient with undifferentiated cervical carcinoma. The patients were categorized according to the type of surgery, namely, primary surgery (12 patients) or surgery due to cancer recurrence (32 patients). Results: In the group of patients with recurrent cervical cancer, we found that improved OS correlated with the SCC histological type and the presence of vaginal fistula. The need for reoperation within 30 days and the presence of severe adverse events significantly worsened the prognosis. We found a non significant trend toward improved survival in those patients with tumor-free margins. Lymph node metastases, the initial stage of the disease, the time to recurrence, and a history of hysterectomy had no impact on patients' OS. In the group of patients undergoing primary PE, we observed a trend toward improved survival among those diagnosed with vaginal fistula. Conclusions: Pelvic exenteration seemed to improve the long-term outcomes for patients with SCC cancer recurrence and vaginal fistula whose surgery was unrelated to severe adverse events.

Primary pelvic exenteration: Our experience with 23 patients from a single institution

“…The most important parameter in the evaluation of risk related to the operative procedure is the mortality rate. Since the initial description, mortality rates have improved from higher than 30% to more acceptable rates of 0 to 10% with 5-year OS varying between 20 and 60%, despite the high morbidity rate (5)(6)(7)(8)(9)(10)(11)(12)(13)(14)(21)(22)(23)(24). In the present study, there was one perioperative death (4.3%) due to a sudden pulmonary embolism, despite prophylactic anticoagulant protocol during hospitalization and home discharge and patient early mobilization.…”

“…In our study, 11 out of the 23 patients (47.8%) with primary pelvic exenterations had fistulas at the moment of surgery, a condition that inevitably alters the quality of life of these patients and that will not be solved by oncologic treatment. The 5-year OS after pelvic exenterations which ranges between 20 and 60% in all studies, when the oncological indications and contraindications are respected (5)(6)(7)(8)(9)(10)(11)(12)(13)(14)(22)(23)(24)(25)(26), is similar or higher compared to the OS after chemoradiotherapy for these advanced pelvic cancers, considered separately. Kramer et al (25) reported that 22% of his patients who underwent radiochemotherapy for locally advanced cervical cancer with curative intent developed fistulas, and the 5-year survival rate was 18%.…”

Primary pelvic exenteration for locally advanced pelvic malignancies

“…In our study, 11 out of the 23 patients (47.8%) with primary pelvic exenteration had urinary or rectal stulas at the moment of surgery, a condition that will alter enormously their quality of life and that will not be solved by oncologic treatment. The 5-year overall survival after pelvic exenteration, which ranges between 20% and 60% in all studies, when the oncological indications and contraindications are respected [5][6][7][8][9][10][11][12][13][14][22][23][24][25][26], is similar or higher compared to overall survival after chemoradiotherapy for these advanced pelvic cancers, considered separately. Kramer [25] reported that 22% of his patients who underwent radiochemotherapy for locally advanced cervical cancer with curative intent have developed stulas, and the 5 years survival rate was 18%.…”

Neoadjuvant chemotherapy combined with radical surgery for stage IB2/IIA2 cervical squamous cell carcinoma: a prospective, randomized controlled study of 35 patients

“…Squamous cell carcinoma is the most common pathological type of cervical cancer, followed by cervical adenocarcinoma and cervical adenosquamous carcinoma. Differences exist in the etiology, clinical features, response to radiotherapy and chemotherapy, and prognosis of patients with three pathological types of cervical cancer [16][17][18]. The National Comprehensive Cancer Network guidelines and FIGO guidelines do not distinguish the treatment of cervical adenocarcinoma and cervical adenosquamous carcinoma from that of cervical squamous cell carcinoma [3].…”