Surgical resection of locally recurrent cervical cancer: a single institutional 70 patient series

Abstract

Pelvic recurrence of cervical cancer is a life-threatening situation and only local control can provide hope for remission. The aim of this study was to evaluate the role of surgery in the treatment of cervical cancer recurrence. This retrospective study analyzed a series of 70 patients who underwent resection of cervix locoregional recurrence. Thirteen patients had palliative salvage surgery for pelvic complications. Twenty-nine resections were considered as curative. Fifty recurrences required pelvic exenterations. The hospital mortality rate was 9% and the morbidity rate was 44%. Overall 5-year actuarial survival rate was 23%. Survival was significantly higher: (a) after curative resection and (b) after centropelvic recurrence resection. Local control was obtained in 48% of the cases and 13 patients are alive with a median follow-up of 75 months. In conclusion, the results of this small and heterogen series seem to justify an attempt to resection for centropelvic recurrences whenever possible. Palliative surgery should be reserved to salvage therapy and highly selected patients.

Pelvic Exenteration for Recurrent and Persistent Cervical Cancer

“…We failed, however, to find a significant relationship between the surgical level and marginal status of incisions. Other risk factors of survival included the size of tumors,[ 10 11 ] DFS after primary treatment,[ 11 ] pathological subtypes of malignancies,[ 28 ] metastasis to the mesorectal[ 29 30 31 ] or retroperitoneal[ 32 33 ] lymph nodes, and LVSI. We checked all these factors in the study and found that metastasis to mesorectal lymph nodes and marginal status of the incision remained independent risk factors both for OS and DFS.…”

Prognostic Factors for Curative Pelvic Exenterations in Patients With Recurrent Uterine Cervical or Vaginal Cancer

“…Since the Shingleton et al 12 study in 1989, it has been assumed that the main prognostic factor for DFS and OS is the 13,14 Other known prognostic factors include a recurrence time of less than 18 months or 2 years, 9,15 lymph node involvement at the time of initial treatment, 16 and perinervous invasion. 7 We also determined that 2 previously known factors are prognostic indicators, namely, tumor recurrence size greater than 5 cm 11 and mesorectal lymph node involvement.…”

Adjuvant hysterectomy for treatment of residual disease in patients with cervical cancer treated with radiation therapy

“…With respect to surgical treatment for residual disease after radiation therapy, the most effective method is probably pelvic exenteration (Stanhope et al, 1990). Total pelvic exenteration offers a 5-year survival rate of 23 -50%, but it requires alterations of both the urinary and lower gastrointestinal tracts, and a high rate of Hysterectomy for residual disease in cervical cancer T Ota et al severe postoperative complications, such as infection, injury of the urinary and lower gastrointestinal tracts, and small-bowel obstruction, occur, in addition to a 4 -14% surgery-related mortality rate (Rutledge et al, 1977;Morley et al, 1989;Shingleton et al, 1989;Matthews et al, 1992;Moutardier et al, 2004). The utility of radical hysterectomy, a more conservative procedure, has been reported, but it also has a high rate of complications.…”