Pelvic Exenteration for Recurrent or Persistent Cervical Cancer: Experience of Five Years at the National Cancer Institute in Mexico

Abstract

Cervical cancer constitutes a major health problem in Mexico and other developing countries. The purpose of our study was to assess the experience of a comprehensive national oncological reference center on pelvic exenteration for post-radiotherapy recurrent or persistent cervical cancer, describing the prognostic value of time to recurrence, procedure complications, and survival. Medical records from 42 patients with post-radiotherapy recurrent or persistent cervical cancer who underwent a pelvic exenteration with curative purposes from 1984 to 1989 were retrospectively reviewed. Histological diagnoses were squamous cell carcinoma (32 patients), adenosquamous carcinoma (9 patients), and adenocarcinoma (1 patient). Average follow up was of 56.3 mo after the procedure and global survival at 5 yr was 65.8%. Survival for patients with early recurrence was 56.9% vs 78% for patients with late recurrence (p = 0.05). Complications were observed in 65.3% of the cases with a surgical mortality of 4.8%. Pelvic exenteration is a surgical procedure with high morbidity in spite of the recent medical advances. Pelvic exenteration should not be indicated with palliative purposes owing to the high rate of complications. Patients with tumor persistence or early recurrence have a worse prognosis. In well-selected cases, exenteration may provide a survival benefit.

Health technology assessment

“…Three studies 103,107,124 gave 2-year survival rates: Stanhope et al 103 for the complete population only (75%), Anthopoulos et al 107 based on the type of surgery used (TPE 73%, anterior pelvic exenteration 75%) and Symonds et al 124 according to pelvic lymph node status (positive 29%, negative 54%). Five-year survival rates ranged from 33% to 66% with one very low exception (12%) in Bricker et al 110 The 5-year survival rates after specific types of exenteration were 58% 122 and 71.5% 125 for anterior exenteration and 42% 122 and 64.6% 125 for total exenteration. When there were metastases to pelvic lymph nodes (positive status), 2-25% of patients survived 5 years.…”

“…Twenty case series, [107][108][109][110][111][112][113][114][115][116][117][118][119][120][121][122][123][124][125][126] published between 1953 and 2009, presented results on pelvic exenteration, mostly from the USA (Table 49). The number of patients varied between 14 and 263.…”

State-of-the-Art Treatment and Novel Agents in Local and Distant Recurrences of Cervical Cancer

“…6 patients died during the follow-up. Terán-Porcayo et al [21] performed 42 pelvic exenterations for post-radiotherapy recurrent or persistent cervical cancer. Intra- and postoperative complications were observed in 65% of the patients, with a surgical mortality of 5%.…”

Positron emission tomography/computerised tomography imaging in detecting and managing recurrent cervical cancer: systematic review of evidence, elicitation of subjective probabilities and economic modelling

“…The best-quality RCT found compared cisplatin with no cisplatin with both groups receiving radiotherapy, 127 which gave an overall 5-year survival with cisplatin of 63% and without cisplatin of 59%. Only case series were found on radiotherapy (nine studies [84][85][86][87][88][89][90][91][92] ), chemoradiotherapy (seven studies [93][94][95][96][97][98][99] ), radical hysterectomy (seven studies [100][101][102][103][104][105][106] ) and pelvic exenteration (20 studies [107][108][109][110][111][112][113][114][115][116][117][118][119][120][121][122][123][124][125][126] ). The survival rates varied considerably, depending on the date of publication, characteristics of patients and type of treatment given.…”