Clinical outcome of pelvic exenteration in patients with advanced or recurrent uterine cervical cancer

Abstract

Pelvic exenteration is a feasible surgical procedure in advanced and/or recurrent cervical cancer patients with no associated post-operative mortality, and the only therapeutic option for complete cure or long-term survival; however, post-operative complications frequently occur.

Indications, techniques and outcomes for pelvic exenteration in gynecological malignancy

“…Whereas orthotopic neobladder reconstruction (ONR) is more frequently used diversion -when urethra and pudendal nerve are spared without history of urethral stricture -continent catheterizable pouches with a ureteroenterostomy (CCUD) are the primary modalities for CUD after pelvic exenteration [ 38]. In previously irradiated pelvis, colonic conduits are superior, whereas the ureters can be resected at high level [3,36,38]. There is a trend toward Wallacetype refluxive implantation of the ureters instead of Le Duc-type antirefluxive implantation because complications caused by reflux seem to be less harmful than those of obstructive ureteroenterostomy.…”

“…Combined OS for primary and secondary pelvic exenteration is reported around 41-70% [2][3][4][5][6][7][8]13] with a 5Y-OS of 20-73% [1][2][3][4][5][6][7]13,15], whereas a 5Y-OS of 10-27% is reported in the palliative setting [2,13,15,16 & ,49], which is better when compared with alternatives such as chemo-/radiotherapy [15]. Höckel [19] reported an OS of 55% and a 5Y-OS of 62% after LEER(N ¼ 100, followup ¼ 30 months).…”

“…Pelvic exenteration denotes en bloc removal of multiple viscera and is indicated when no other curative option is left to accomplish local disease control [1][2][3][4][5][6][7][8][9][10][11]12 & ,13]. Total pelvic exenteration defines resection of the female genital tract with salvage of the entire pelvis, including bladder, ureters and anorectum; anterior pelvic exenteration and posterior pelvic exenteration designate resection of solely the distal urinary tract and anorectum as adjacent pelvic organs, respectively.…”

“…Total pelvic exenteration defines resection of the female genital tract with salvage of the entire pelvis, including bladder, ureters and anorectum; anterior pelvic exenteration and posterior pelvic exenteration designate resection of solely the distal urinary tract and anorectum as adjacent pelvic organs, respectively. As its first description [14], perioperative mortality has dropped from 20 to less than 5% [2,3,5], while postoperative 5-year survival (5YS) has reached 20-73% [1][2][3][4][5][6][7][8][9][10][11]12 & , 13, 15,16 & ], displaying a remarkable evolution from palliation to a potential cure [1][2][3][4][5]13,15]. As its first description [14], perioperative mortality has dropped from 20 to less than 5% [2,3,5], while postoperative 5-year survival (5YS) has reached 20-73% [1][2][3][4][5][6][7][8][9][10][11]12 & , 13, 15,16 & ], displaying a remarkable evolution from palliation to a potential cure [1]…”

“…Craniocaudal resection classifies a supralevatory pelvic exenteration and an infralevatory pelvic exenteration with or without vulvectomy [1]. A complete resection (R0) is one of the most important prognostic factors, as microscopic (R1) or macroscopic (R2) residual disease is associated with a decreased overall survival (OS) [1,2,4,5,7, [1][2][3][4]17 & ], lymphvascular invasion and/or perineural invasion, tumor grade [7], size of recurrence [1,3,17 & ], pelvic sidewall involvement, interval between primary treatment and pelvic exenteration [1,2,7,19] and total number of tumor-invaded organs [7]. A complete resection (R0) is one of the most important prognostic factors, as microscopic (R1) or macroscopic (R2) residual disease is associated with a decreased overall survival (OS) [1,2,4,5,7, [1][2][3][4]17 & ], lymphvascular invasion and/or perineural invasion, tumor grade [7], size of recurrence [1,3,17 & ], pelvic sidewall involvement, interval between primary treatment and pelvic exenteration [1,2,7,19] and total number of tumor-invaded organs [7].…”