Long-term clinical outcome of pelvic exenteration in patients with advanced gynecological malignancies

Department of Gynecology and Obstetrics, Charité, Campus Virchow Clinic, University Hospital, Berlin, Germany.
Journal of Surgical Oncology (Impact Factor: 2.84). 05/2010; 101(6):507-12. DOI: 10.1002/jso.21518
Source: PubMed

ABSTRACT We evaluated the outcome of pelvic exenteration in women with locally advanced primary or recurrent gynecological malignancies.
All pelvic exenteration procedures performed between 01/2003 and 06/2009 were evaluated. Extent of surgical radicality, operative techniques, and outcome were evaluated. Kaplan-Meier curves were calculated for Overall (OS) and progression-free survival (PFS).
Forty-seven patients (median age: 52.5 years) were evaluated. Ten of 47 patients (21.3%) had a primary and 37(78.7%) a relapsed cancer. Most common (80.8%) site of origin was the cervix. Patients (80.8%) had undergone previous pelvic irradiation. A total exenteration was performed in 32/47 patients (68%). A complete tumor resection was obtained in 23 patients (49%). Thirty-three patients (70.2%) had at least one major complication, including ileus (8.5%), intestinal-fistula (29.8%), ureteral anastomotic insufficiency (6.4%), abscess (6.4%), and cardiothrombotic events (23.4%). At a median follow-up of 7 months (range: 1-42), 22/47 patients (46.8%) died and 22/47 (46.8%) experienced a relapse. Median OS was 4 months (range: 0.1-16) and 22 months (range: 6-42) for patients with versus without postoperative tumor residuals, respectively (P = 0.0006), while median PFS was 4 months (range:0.1-16) versus 12 months (range: 6-42) (P < 0.0001).
Radical pelvic exenteration due to advanced pelvic malignancies may be associated with a high morbidity. Complete tumor resection is associated with a significantly higher overall and PFS.

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    • "The margin status is an important factor that is consistently associated with prognosis. Overall and progression-free survival are better following complete tumor resection [23] [24]. Moreover, in previous series by Berek et al. [5] and Shingleton et al. [25], no patient survived 3 years following exenteration when the surgical margins were positive. "
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    • "Subsequently, Magrina et al. [27] [28] classified pelvic exenteration according to levator ani muscle which seemed to be more accurate and useful, classifying the procedure into four groups: supraelevator, infraelevator, infraelevator þ vulvectomy and extended. Overall morbidity after the procedure is close to 70% [29] [30]. "
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