Pelvic exenteration for the treatment of gynecological malignancies

Abstract

Twenty-three patients undergoing pelvic exenteration for primary and recurrent gynecological malignancies from 1976 to 1994 are reported. Fifteen patients underwent total pelvic exenteration, 3 underwent anterior exenteration, and 5 underwent a posterior procedure. Eight patients had exenteration as their primary treatment (primary group), and 15 underwent exenteration as secondary treatment (recurrent group). In the primary group, two patients developed recurrence and died of it at 6 and 20 months after operation. Five patients are still being followed up and are alive without disease. Four of these 5 patients have survived more than 5 years. In the recurrent group, 12 patients were followed up and three died of complications during the early years. Seven patients died of cancer with the mean survival time of 16.6 months. The mean age, average operating time, and mean blood loss in the primary and recurrent groups were 57 vs. 53 years, 8 hours and 20 min vs. 8 hours and 10 min, and 4,120 vs. 4,190 ml, respectively. The overall cumulative 5-year survival rate was 34.7%, being 68.6% in the primary group and 16.7% in the recurrent group. It is noteworthy that the 5-year survival rate was 51.3% in the patients who had surgical margins free of disease. In conclusion, pelvic exenteration should be considered an acceptable therapeutic option when appropriately selected.

Radical surgical treatement in pelvic advanced cancer

“…Massive invasive tumors (even in the absence of distant metastases) respond poorly to radiotherapy and chemotherapy and no study up to the present was able to demonstrate that these treatment options can influence the patient's life expectancy in the absence of complete resection of tumoral tissue (the only chance of healing) (72)(73)(74)(75)(76)(77)(78)(79)(80)(81)(82).…”

“…On the other hand, palliative TPE determines a significant relief of symptoms, in 88% of cases after BROPHY -1994 (149), in 70% by YEUNG -1993 (150) and in 90% after WANEBO -1987 (151-153). Most authors agree that because of the remaining macroscopic tumor tissue the disease will progress inexorably and, although on a short-term a relief of symptoms can be noticed (for 3 to 4 months), the patient is likely to die before a significant improvement in the quality of life is achieved, not to mention the risk of losing the patients because of the significant morbidity of a surgical procedure performed on very poor biological subjects (11,14,25,27,29). None of the 37 patients on which we performed palliative TPE survive more than 6 to 12 months, probably as much as they would have lived with simple urinary and fecal diversions.…”

“…Nowadays the operative mortality ranges between 3% and 5% and the postoperative morbidity between 30% and 44%, acceptable and reasonable figures given the scale of the intervention and that the 5-year survival rate of patients who passed the surgical procedure ranges between 30% and 62% (3,11,12,20,(83)(84)(85)(86)(87)(88)(89)(90).…”

“…This particular development can not be assessed in time, but is often long enough to allow therapeutic intervention (1,2,(9)(10)(11)(12)(13). The term locally advanced pelvic cancer refers not only to the cancers of the pelvic organs developing "de novo" with massive invasion locally (or are diagnosed only at this stage) but also to the local-invasive recurrences of these cancers, the pelvic region (clear or apparent) being the only location of the neoplasia.…”

Does intra-operative radiation at the time of pelvic exenteration improve survival for patients with recurrent, previously irradiated cervical, vaginal, or vulvar cancer?

“…In those patients in whom cure is the goal of the procedure, and have disease that is truly limited to the pelvis, five-year survival rates are approximately 30-60% [1][2][3][4][5][6][7][8][9][10][11]. Those who are candidates for a curative procedure are almost always radiated with full dose radiation to the pelvis, and may even need a laterally extended endopelvic resection (LEER) to render them free of disease [12,13].…”