Pelvic exenteration as treatment of recurrent or advanced gynecologic and urologic cancer

Abstract

Pelvic exenteration is used as therapeutic option for advanced or recurrent cancer in the pelvis. We determined the complications of and the survival after pelvic exenteration. The study was performed as a retrospective cohort (n = 62) study from January 1, 1989, until January 1, 2000. Descriptive statistics were used. Survival was estimated according to the Kaplan-Meier life table. The operative mortality was 1.6%. Seventy-five percent of the patients had postoperative complications of which ileus and urinary tract infection were the most common. Late complications occurred in 83% of the patients. Recurrent disease was observed in 38% of the women, whereas 50% had died on January 1, 2000. Five-years disease-free and overall survival were 42% (confidence interval [CI] +/- 14%) and 46% (CI +/- 14%), respectively. Elderly patients (> 70 years old) do not experience more complications. Despite considerable morbidity, pelvic exenteration is a therapeutic option for survival, even for patients of 70 years and older.

The Role of Exenterative Surgery and Urinary Diversion in Persistent or Locally Recurrent Gynecological Malignancy: Complications and Survival

“…Salvage surgery is extensive and mainly involves the urinary tract (bladder, urethra and ureters) requiring urinary diversion, but interdisciplinary collaboration is a prerequisite. However, mortality rates of up to 11% reported in earlier series may be discouraging [5,6,10,13] . Indeed, complications do occur, especially when taking the 51% of patients who underwent previous radiation therapy into account [5,6,14,15] , but the majority of these complications can be managed conservatively and do not require additional surgery.…”

“…NCT00217633). Despite these encouraging results, there are only a limited number of reports on exenterative procedures [5,6,14,15] . The reason for the reluctance to perform radical surgery is unclear.…”

“…The literature on pelvic exenteration is sparse, with complication rates for radical exenterative surgery (anterior, posterior or complete) and urinary diversion ranging up to 75% for early and 83% for late postoperative complications [5,6] . The goal of this study was to evaluate if these women profit from this extensive and mutilating surgery and if there is a chance of cure.…”

Salvage Stereotactic Body Radiosurgery in the Management of Recurrent Gynecological Cancer

“…12 The complication rates for radical exenterative surgery can be as high as 75% for early and83% for late complications. [13][14][15] Systemic salvage chemotherapyis mainly considered palliative due to low response rates and negligible impact on long term survival. In a literature review by Pectasides et al 16 , the response rates to single agent chemotherapy ranged between 7-68% with the highest rates reported with cisplatinum.…”

Electrothermal bipolar coagulation decreases the rate of red blood cell transfusions for pelvic exenterations

“…Some of the most common complications include excessive blood loss, pelvic infection, wound dehiscence, urinary fistula or obstruction, ostomy breakdown or obstruction, pulmonary embolus, and postoperative hemorrhage [4][5][6][7]. Newer techniques may be making it possible to perform pelvic exenteration in obese patients, who traditionally were thought to be poor candidates [8].…”