Survival After Pelvic Exenteration for Cervical Cancer: A National Cancer Database Study

Graves, Stephen; Seagle, Brandon Luke L.; Strohl, Anna E.; Shahabi, Shohreh; Nieves-Neira, Wilberto

doi:10.1097/igc.0000000000000884

Cited by 30 publications

(19 citation statements)

References 24 publications

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“…High rates of morbidity and mortality and poor quality of life (QOL) have been associated with this surgical treatment. More recently, preoperative imaging, multidisciplinary surgical care, new surgical techniques, including those designed to eliminate the need for stomas, and advances in perioperative and postoperative care have produced 5‐year survival rates as high as 60% in the carefully selected gynecologic cancer patient, including those with endometrial, vulvar, or ovarian cancers . The result is a growing cohort of women living longer with the physical and psychological challenges associated with such a radical surgery …”

Section: Introductionmentioning

confidence: 99%

Quality of life after pelvic exenteration for gynecologic cancer: Findings from a qualitative study

et al. 2018

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Section: Introductionmentioning

confidence: 99%

Quality of life after pelvic exenteration for gynecologic cancer: Findings from a qualitative study

et al. 2018

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“…Treatment in these patients is individualized according to the site of relapse and the patient’s performance status. In only a few patients, long-term survival can be achieved by radical surgery or radiotherapy of a central pelvic relapse or solitary distant metastasis [3]. Other than that, platinum-based chemotherapy is the mainstay for these patients.…”

Section: Introductionmentioning

confidence: 99%

Factors associated with post-relapse survival in patients with recurrent cervical cancer: the value of the inflammation-based Glasgow Prognostic Score

Seebacher

Sturdza

Bergmeister

et al. 2018

Arch Gynecol Obstet

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PurposeThe aim of the present study was to assess the value of the Glasgow Prognostic Score (GPS) as a prognostic tool for predicting post-relapse survival (PRS) in patients with recurrent cervical cancer.MethodsWe retrospectively evaluated the data of 116 patients with recurrent cervical cancer in whom serologic biomarkers had been assessed at the time of relapse. The GPS was calculated as follows: patients with elevated serum C-reactive protein levels and hypoalbuminemia were allocated a score of 2, and those with 1 or no abnormal value were allocated a score of 1 and 0, respectively. To assess the association between factors including the GPS and PRS, we performed uni- and multivariate survival analyzes.ResultsAfter a median follow-up of 20.9 months from recurrence, a 5-year PRS rate of 25% (SE 4.7%) was observed. Only in 29.8% of the patients, recurrence was limited to the pelvis. In uni- and multivariate survival analyzes, the GPS [HR 1.6 (95% CI 0.9–2.4), p = 0.01], a history of radiation therapy as part of initial treatment [HR 2.7 (95% CI 1.1–6.9), p = 0.03], and the presence of peritoneal carcinomatosis or multiple sites of relapse [HR 4.2 (95% CI 1.9–9.3), p < 0.001] were associated with shorter PRS. The GPS correlated with higher squamous cell carcinoma antigen levels (p = 0.001), shorter median PRS (p = 0.009), and less intensive treatment for relapse (p = 0.02).ConclusionsA higher GPS at the time of relapse, a history of radiation therapy, and the presence of peritoneal carcinomatosis or multiple sites of relapse are independently associated with shorter PRS in patients with recurrent cervical cancer.

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“…Perioperative mortality in more recent studies ranges between 0% and 9% [2][3][4][5][6][7][8][9][10][11][12][13][14][15][16][17]20]. In the present series, there were four deaths in the first 30 days after surgery in 59 patients -a quite high perioperative mortality of 6.6 %; nonetheless two of the four perioperative deaths were caused by cardiovascular reasons.…”

Section: Discussionmentioning

confidence: 58%

“…Because of substantial improvements in operative and reconstructive techniques, the mortality and morbidity rates of pelvic exenteration have decreased and its survival rate is continuously increasing. Nonetheless, it is considered an extremely difficult and demanding procedure for both surgeon and anaesthesiologist, with an intra-and perioperative mortality between 0% and 9% [2][3][4][5][6][7][8][9][10][11][12][13][14][15][16], but if successful, for those patients without other alternative curative option, the five-year survival rate ranges between 20% and 60% [2][3][4][5][6][7][8][9][10][11][12][13][14][15][16]. The improvements to this technique have enhanced the results and patients' quality of life.…”

Section: Introductionmentioning

confidence: 99%

Surgical complications and survival after pelvic exenteration: our experience following 60 procedures

2020

EJGO

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Purpose of Investigation: Analyse the results of pelvic exenteration for pelvic malignancies in a tertiary referral center. Materials and methods: Between 2011 and 2018, 60 patients underwent a pelvic exenteration. The indications were cervical (44 patients), vaginal (4), recurrent ovarian (6), endometrial (2), vulval (2), recurrent sigmoid colon (1), and bladder cancer (1). Results: Out of the 60 exenterations, 31 were total, 21 anterior, and 8 posterior. A Bricker non-continent ileal or sigmoid urinary conduit was performed in 51 out of 52 anterior and total exenterations. Early complications occurred in 34 patients of whom four perioperative deaths (6.6 %). Among the 60 patients, at this moment, 33 are alive, 25 are dead, and two are lost to follow-up. Conclusion: Pelvic exenteration for recurrent or advanced pelvic malignancies can be associated with long-term survival and even cure without high perioperative mortality in properly selected patients. However, postoperative complications can be lethal.

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Survival After Pelvic Exenteration for Cervical Cancer: A National Cancer Database Study

Abstract: Exenteration may be curative for more than half of women with node-negative cervical cancer. Stage, insurance status, lymph node status, and surgical margin are independently associated with differential OS after exenteration.

Cited by 30 publications

References 24 publications

Quality of life after pelvic exenteration for gynecologic cancer: Findings from a qualitative study

Quality of life after pelvic exenteration for gynecologic cancer: Findings from a qualitative study

Factors associated with post-relapse survival in patients with recurrent cervical cancer: the value of the inflammation-based Glasgow Prognostic Score

Surgical complications and survival after pelvic exenteration: our experience following 60 procedures

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