Total Infralevatorian Exenteration with Vulvectomy as Salvage Therapy in a Recurrent Irradiated Cervical Cancer with Pelvic Sidewall Involvement

Abstract

Despite the available effective screening techniques, cervical cancer is the most common genital malignancy in Romania. In patients with isolated pelvic recurrence after radiotherapy, exenteration represents the only chance for curative treatment. We present the case of a 45-year-old patient with a massive pelvic tumour causing intensive, poorly controlled vaginal bleeding, bilateral hydronephrosis and chronic renal failure. She underwent total infralevatorian exenteration with vulvectomy. Postoperative recovery was uneventful, and she presented a good evolution in the two months following surgery. We consider pelvic exenteration as the last treatment option to cure irradiated pelvic tumour recurrences. CASE REPORTWe present the case of a 45-year-old patient who was diagnosed with stage IIB squamous cervical carcinoma, complaining of atypical vaginal bleeding. She was referred to chemo-radiotherapy with curative intent. After five years she relapsed, complaining of lower abdominal pain and vaginal bleeding. Transrectal ultrasound (Figure 1) and magnetic resonance scan revealed a tumor of 8 × 4 cm, invading the parametrium bilaterally, the urinary bladder, the rectum, vagina, distal urethra, and the right internal iliac vessels. No distant metastases were described. The patient developed bilateral hydronephrosis with a nonfunctional right kidney. In September 2016, the patient had been admitted for intensive vaginal bleeding in order to attempt hemostasis and for blood transfusions.