Pelvic Exenteration for Recurrent and Persistent Cervical Cancer

Abstract

Background:Pelvic exenteration (PE) for primary and recurrent cervical cancer has resulted in favorable survival outcomes, but there are controversies about specific prognosis factors, and up to now, there have been no published reports from China. This study aimed to share our experiences of PE, which were performed in a single institution.Methods:From January 2009 to January 2016, 38 patients with recurrent or persistent cervical cancer were included in the study, and they were followed up until January 2017. Epidemiological and clinicopathological characteristics of patients were compared for survival outcomes in univariate and Cox hazard regression analysis.Results:There were thirty-one and seven patients with recurrent and persistent cervical cancer, respectively. The median age of patients was 45 years (range 29–65 years). Total, anterior, and posterior PE consisted of 52.6%, 28.9%, and 18.4% of cases, respectively. Early and late complications occurred in 21 (55.3%) patients and 15 (39.5%) patients, respectively. Two (5.3%) patients died due to complications related to surgeries within 3 months after PE. The median overall survival (OS) and disease-free survival (DFS) were 28.5 months (range 9–96 months) and 23 months (range 4–96 months), respectively, and 5-year OS and DFS were 48% and 40%, respectively. Cox hazard regression analysis showed that, the margin status of the incision and mesorectal lymph node status were independent risk factors for OS and DFS.Conclusion:In our patients with recurrent and persistent cervical cancer, the practice of PE might achieve favorable survival outcomes.Trial Registration:ClinicalTrials.gov, NCT03291275; https://clinicaltrials.gov/ct2/show/NCT03291275?term=NCT03291275&rank=1.

Selection of Treatment Regimens for Recurrent Cervical Cancer

“…For patients with central pelvic relapse without pelvic wall involvement or extrapelvic spread of the disease after previous radiation, pelvic exenteration is usually indicated as the curative approach but has high extensive surgery-related morbidity and mortality ( 9 , 21 , 29 – 31 ). Pelvic exenteration achieved a 5-year OS of 40% ( 32 , 33 ) similar to the 5-year OS of 39% in this study. On the other hand, surgical therapy plays an important role in the treatment of recurrence beyond the pelvic cavity, especially for oligometastatic disease ( 34 ).…”

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

“…Furthermore, in our study, we had a comparable number of patients with SCC cancers and with cervical adenocarcinomas. By contrast, De Georgio et al [2] included a small number of cervical adenocarcinoma patients (7) in their study, and Baclabas et al [3] included patients with pelvic malignancies of various origin, such as rectal and ovarian cancers.…”

“…Exenteration may prove therapeutic for more than half of women with node-negative cervical cancer. The stage of the disease, health insurance status, lymph node status, and surgical margins are also independently associated with differential OS after exenteration [14], as are lymphovascular space invasion (LVSI), metastasis to mesorectal lymph nodes, tumor-free margins, and disease-free survival [7]. In a study by De Georgio et al, patients without LVSI had significantly better overall survival [2].…”

“…Thus, the achievement of R0 resection remains the most important determinant of survival benefit [ 4 – 6 , 10 ]. De Gregorio observed a 34.4% 5-year survival rate when R0 was achieved [ 2 ] while Li et al showed that the positive margin of incision was an independent risk factor for poorer overall survival [ 7 ]. R1 resection cases were associated with a significantly worse prognosis with a median overall survival time of 10.4 months [ 3 ].…”

“…Nevertheless, the survival benefit of the procedure has been well documented, particularly in cases of cervical cancer relapse where negative resection (R0) margins can be achieved [ 2 , 3 ]. Achieving an R0 resection is possible in more than 70% of cases and remains one of the most important determinants of survival benefit [ 4 – 7 ]. For this reason, PE is becoming a therapeutic option for an increasing number of cases of pelvic malignancy recurrence.…”