Indications, techniques and outcomes for pelvic exenteration in gynecological malignancy

Abstract

Pelvic exenteration is indicated when curative alternatives are inferior or exhausted for advanced primary or locally gynecological recurrent cancer confined to the pelvis. Palliative pelvic exenteration should only be considered when disease-related morbidity is uncontrollable with other therapeutic modalities. Modifications in different surgical steps are still evolving to decrease the pelvic exenteration associated high morbidity. A complete resection and lymph node invasion free status are directly related to a better prognosis.

Survival After Pelvic Exenteration for Cervical Cancer: A National Cancer Database Study

“…4,7Y16 Current generally accepted indications for pelvic exenteration with curative intent in cervical cancer are patients with centrally persistent or recurrent disease to locally advanced primary cancers. 2,15,17 Pelvic sidewall recurrences are no longer an absolute contraindication. 5,7,8,12,17,18,23 Increasing age and stage were, expectedly, associated with increased hazard for death.…”

“…Over the past 60 years, numerous new techniques in resection and pelvic reconstruction were developed. 2 Improved patient selection and technical advances have decreased perioperative mortality rates from 20% to less than 5%, and produced postoperative 5-year overall survival (OS) rates of 20% to 73%. 1,3Y16 Several prognostic factors have been identified, with complete resection being the most prognostic factor for OS.…”

“…2,5Y10,12 Other important prognostic factors are lymph node involvement, tumor grade, size of recurrent tumor, and interval between primary treatment and pelvic exenteration. 2,5,6,8,10,12 Absolute contraindications for pelvic exenteration include peritoneal and extrapelvic metastases. 5,9,12,17 Lymph node status is controversial as a contraindication for exenteration.…”

“…Some authorities view nodal metastasis as a contraindication for exenteration, especially positive paraaortic nodes. 2,6,7 Other authors may not view positive lymph nodes, either pelvic or paraaortic, as a strict contraindication to exenteration. 8Y10 Despite advancements in surgical technique and increased appreciation of prognostic factors, much remains unclear including the prognostic value of histologic type and advancing age.…”

“…8Y10 Despite advancements in surgical technique and increased appreciation of prognostic factors, much remains unclear including the prognostic value of histologic type and advancing age. 2,18,19 Clarification of factors that may be prognostic or relative contraindications to exenteration has been limited by the small sample size of previously reported series, numbering 20 to 282 cases. 6,10,11,14,16 A significant number of studies were performed before the development of techniques that improved OS and that could potentially reduce morbidity and complication rates, or before the use of chemoradiation for primary disease.…”