Background: Pelvic exenteration can be performed in selected patients with locally advanced primary or recurrent gynecologic malignancies. However, data on long-term outcomes are scarce. Objective: The aim of this study was to describe the current authors' experience of performing pelvic exenteration in patients with locally advanced primary and recurrent gynecologic malignancies. Materials and Methods: A retrospective study of all patients who underwent pelvic exenterations for gynecologic malignancies from January 1982 to June 2011 was performed. Results: Fifty-nine females (mean age: 54; standard deviation: 13.5 years), underwent pelvic exenteration (24 [40.7%] total, 35 [59.3%] near total) for advanced gynecologic malignancies. Ovarian and cervical cancers were most frequently seen in 27 (45.8%) and 17 (28.8%) patients, respectively. Although there was no inpatient mortality, 26 (44%) patients developed perioperative complications. Urologic complications occurred in 10 (17%) patients. One patient had significant postoperative hemorrhage that required operative intervention, while 3 patients required radiologic-guided drainage for intra-abdominal abscesses. Oncologically, 29 (49.2%) patients had R0 margins, 14 (23.7%) had R1 margins, while 8 (13.6%) had R2 margins. Over a median follow-up period of 12 years (range: 13–364 months), 41 (70%) patients died. The overall median survival was 4 years, with some potential differences according to the site of the initial primary cancers, with 83% of patients with endometrial cancers surviving at 5 years. Conclusions: Pelvic exenteration for locally advanced gynecologic malignancies is associated with acceptable short- and long-term outcomes but has considerable perioperative complication rates. The results of the current study are comparable with exenteration outcomes for other advanced and recurrent pelvic malignancies. (J GYNECOL SURG 30:255)
Get full access to this article
View all access options for this article.
References
1.
BrunschwigA. Complete excision of pelvic viscera for advanced carcinoma: A one-stage abdominoperineal operation with end colostomy and bilateral ureteral implantation into the colon above the colostomy. Cancer, 1948; 1:177.
2.
GoldbergJM, PiverMS, HemplingRE. Improvements in pelvic exenteration: Factors responsible for reducing morbidity and mortality. Ann Surg Oncol, 1998; 5:399.
3.
HöckelM, DornhöferN. Pelvic exenteration for gynaecological tumours: Achievements and unanswered questions. Lancet Oncol, 2006; 7:837.
4.
AveretteH, LichtingerM, SevinB, GirtannerR. Pelvic exenteration: A 15 year experience in a general metropolitan hospital. Am J Obstet Gynecol, 1984; 150:179.
5.
AndikyanV, Khoury-ColladoF, GerstSR, et al.Anterior pelvic exenteration with total vaginectomy for recurrent or persistent genitourinary malignancies: Review of surgical technique, complications, and outcome. Gynecol Oncol, 2012; 126:346.
KasamatsuT, OndaT, YamadaT, TsunematsuR. Clinical aspects and prognosis of pelvic recurrence of cervical carcinoma. Int J Gynaecol Obstet, 2005; 89:39.
9.
LawheadR, ClarkD, SmithD, PierceV, LewisJ. Pelvic exenteration for recurrent or persistent gynecologic malignancies: A 10-year review of the Memorial Sloan-Kettering Cancer Center Experience (1972–1981). Gynecol Oncol, 1989; 33:279.
10.
TiexeiraSC, FerenschildFT, SolomonMJ, et al.Urological leaks after pelvic exenterations: Comparing formation of colonic and ileal conduits. Eur J Surg Oncol, 2012; 38:361.
11.
BerekJS, HoweC, LagasseLD, HackerNF. Pelvic exenteration for recurrent gynecologic malignancy: Survival and morbidity analysis of the 45-year experience at UCLA. Gynecol Oncol, 2005; 99:153.
12.
de WiltJH, van LeeuwenDH, LogmansA, VerhoefC, KirkelsWJ, VermaasM, AnsinkAC. Pelvic exenteration for primary and recurrent gynaecological malignancies. Eur J Obstet Gynecol Reprod Biol, 2007; 134:243.
13.
GoldbergGL, SukumvanichP, EinsteinMH, SmithHO, AndersonPS, FieldsAL. Total pelvic exenteration: The Albert Einstein College of Medicine/Montefiore Medical Center Experience (1987 to 2003). Gynecol Oncol, 2006; 101:261.
14.
HatchKD, GelderMS, SoongSJ, BakerVV, ShingletonHM. Pelvic exenteration with low rectal anastomosis: Survival, complications, and prognostic factors. Gynecol Oncol, 1990; 38:462.
HectorRC, AlfonsoT, MarioDLG, DimasH, LemuelH. Pelvic exenteration for carcinoma of the cervix: Analysis of 252 cases. J Surg Oncol, 1998; 38:121.
17.
KaurM, JoniauS, D'HoorA, et al.Pelvic exenterations for gynecological malignancies: A study of 36 Cases. Int J Gynecol Cancer, 2012:22; 889.
18.
MaggioniA, et al.Pelvic exenteration: Ten-year experience at the European Institute of Oncology in Milan. Gynecol Oncol, 2009; 114:64.
19.
MagrinaJ, StanhopeR, WeaverA. Pelvic exenterations: Supralevator, infralevator, and with vulvectomy. Gynecol Oncol, 1997; 64:130.
20.
MatthewsC, MorrisM, BurkeT, GershensonD, WhartonT, RutledgeF. Pelvic exenteration in the elderly patient. Obstet Gynecol, 1992; 79:773.
21.
MorrisM, AlvarezRD, KinneyWK, WilsonTO. Treatment of recurrent adenocarcinoma of the endometrium with pelvic exenteration. Gynecol Oncol, 1996; 60:288.
22.
MorleyG, HopkinsM, LindenauerS, RobertsJ. Pelvic exenteration, University of Michigan: 100 patients at 5 years. Obstet Gynecol, 1989; 74:934.
23.
RobertsW, CavanaghD, BrysonP, LymanG, HewittS. Major morbidity after pelvic exenteration: A seven year experience. Obstet Gynecol, 1987; 69:617.
24.
Rodriquez-BigasMA, PetrelliNJ. Pelvic exenterations and its modifications. Am J Surg, 1996; 171:293.
25.
RoosEJ, Van EijkerenMA, BoonTA, HeintzAP. Pelvic exenteration as treatment of recurrent or advanced gynecologic and urologic cancer. Int J Gynecol Cancer, 2005; 15:624.
26.
RutledgeF, SmithJ, WhartonJ, O'QuinnA. Pelvic exenteration: Analysis of 296 patients. Am J Obstet Gynecol, 1977; 129:881.
27.
SharmaS, OdunsiK, DriscollD, LeleS. Pelvic exenterations for gynecological malignancies: 20-year experience at Roswell Park Cancer Institute. Int J Gynecol Cancer, 2005; 15:475.
28.
SymmondsRE, PrattJH, WebbMJ. Exenterative operations: Experience with 198 patients. Am J Obstet Gynecol, 1975; 121:907.
29.
JacombsASW, RomeP, HarrisonJD, SolomonMJ. Assessment of the selection process for myocutaneous flap repair and surgical complications in pelvic exenteration surgery. Br J Surg, 2013; 100:561.
30.
AustinKKS, SolomonMJ. Pelvic exenteration with en bloc iliac vessel resection for lateral pelvic wall involvement. Dis Colon Rectum, 2009; 52:1223.
31.
MilneT, SolomonMJ, LeeP, YoungJM, StalleyP, HarrisonJD. Assessing the impact of a sacral resection on morbidity and survival after extended radical surgery for locally recurrent rectal cancer. Ann Surg, 2013; 258:1007.
32.
AustinK, YoungJM, SolomonMJ. Quality of life of survivors after pelvic exenteration for rectal cancer. Dis Colon Rectum, 2010; 53:1121.
