Primary pelvic exenteration: Our experience with 23 patients from a single institution

Abstract

This study was designed with an aim to share our experience of primary pelvic exenterations. The study included 23 patients with different types of pelvic cancer enrolled at a single institution between November 2011 and July 2020. The patient mean age was 55 years (range, 43-72 years) and the oncological indications included: Stage IVa cervical cancer (11 cases, 48.9%), stage IVa endometrial cancer (1 case, 4.3%), stage IVa vaginal cancer (6 cases, 26%), stage IIIb bladder cancer (3 cases, 13%), stage IIIc rectal cancer (1 case, 4.3%) and undifferentiated pelvic sarcoma (1 case, 4.3%). Total, anterior, and posterior pelvic exenterations were performed on 34.4, 56.5 and 13% of cases, respectively. Related to levator ani muscle, 13 (56.5%) pelvic exenterations were supralevatorian, 10 (43.5%) infralevatorian, and 5 (21.7%) were infralevatorian with vulvectomy. No major intraoperative complications occurred. Seven patients (30.5%) developed early complications, 4 of them (17.4%) required reoperation and 1 (4.3%) perioperative death caused by a pulmonary embolism was recorded. Only 1 patient experienced a late complication, a urostomy stenosis. Over a median follow-up period of 35 months, 8 (34.8%) patients died. The median overall survival (OS) was 33 months (range, 1-96 months). The 2-year and 5-year survival rates were 72 and 66%, respectively. Primary pelvic exenteration may be related with various postoperative complications, without high perioperative morality and with long-term survival.

Is long-term survival possible when conventional cervical cancer treatment options are exhausted?

“…Total pelvic exenteration as a technique was introduced mainly for palliation of advanced pelvic malignancy [5,8,[16][17][18]. However, in recent years it has been performed with curative intent in the treatment of locally advanced and recurrent pelvic malignancies [11]. In locally advanced pelvic tumors, TPE which achieves complete resection is the only chance for cure.…”

“…Outcomes in surgical oncology depend on the skill of the surgeon as well as the volume of surgery performed [9]. After TPE, the five-year survival rates for patients with primary disease range between 15% and 77.6% and in patients with recurrent disease from 0% to 23% [7,10,11]. Careful selection for TPE is of paramount importance [12] yet no previous study has been conducted in Estonia to inform patient selection parameters.…”

The Role of Pelvic Exenteration in Cervical Cancer: A Review of the Literature

“…Overall survival is defined as the time from exenteration to death. Table 5 lists the cohorts of patients who have undergone the procedure with their respective overall survival rates, which range from 22 to 70% [4][5][6]9,11,12,14,31,33,35,79,81,84,87,[90][91][92][93][94]. Considering only cervical cancer, the 5-year overall survival rate ranged from 23.8 to 51% [6,11,14,84,92,93].…”

A Novel Classification of Posterior Pelvic Exenteration to Assess Prognosis in Female Patients with Locally Advanced Primary Rectal Cancer: A Retrospective Cohort Study from China PelvEx Collaborative

“…The vagina was wholly preserved (Fig. 1A), with subsequent suturing and performance of colorectal anastomosis or Hartmann's procedure [14,15]. PPE-II encompassed cases of middle or low rectal cancer in ltration into the upper vagina or cervix, warranting low anterior resection (LAR) and hysterectomy coupled with upper vaginal dissection.…”