Extended pelvic resections for recurrent or persistent uterine and cervical malignancies: An update on out of the box surgery

Abstract

ObjectiveTo update our report on the outcome of patients who underwent extended pelvic resection (EPR) for recurrent or persistent uterine and cervical malignancies. MethodsWe reviewed the records of all patients who underwent EPR between 6/2000 and 07/2011. EPR was defined as an en-bloc resection of a pelvic tumor with sidewall muscle, bone, major nerve, and/or major vascular structure. Complications up to 180days post surgery were analyzed. Survivals were estimated using the Kaplan–Meier method. ResultsWe identified 22 patients. Median age at the time of EPR was 58years (range, 36–74). Median tumor diameter was 5.4cm (range, 1.5–11.2). Primary tumor sites included: uterus, 13; cervix, 7; synchronous uterus/cervix, 1; and synchronous uterus/ovary, 1. The EPR structures were: muscle, 13; nerve, 10; bone, 8; vessel, 5. Complete gross resection with microscopically negative margins (R0 resection) was achieved in 17 patients (77%). There were no perioperative mortalities. Major postoperative complications occurred in 14 patients (64%). The two most common morbidities were pelvic abscesses and peripheral neuropathies. Median follow-up time was 28months (range, 6–99). The 5-year overall survival (OS) for the entire cohort was 34% (95% CI, 13–57). For the 17 patients who had an R0 resection, the 5-year OS was 48% (95% CI, 19–73). In patients with positive pathologic margins (n=5), the 5-year OS was 0%. ConclusionEPR was associated with prolonged survival when an R0 resection was achieved. The high rate of postoperative complications remains a hallmark of these procedures and properly selected patients should be extensively counseled preoperatively.