Laterally Extended Endopelvic Resection as a Salvage Procedure for Locally Advanced And Recurrent Cervical Cancers: A Single-Institution Experience

Abstract

Locally advanced and recurrent cervical cancer involving up to sidewall where the complete negative margin was not achieved usually had a low cure rate and a poor 2-year survival. Laterally extended endopelvic resection (LEER) described by Hockel et al. is a novel approach in these cases in which complete negative margin (R0) can be achieved with adequate local control and better survival. In this study, we analyzed our 5-year experience and outcome after LEER for locally advanced and recurrent cervical cancer. This is a retrospective study of patients who underwent Laterally Extended Endo-pelvic Resection for locally advanced and recurrent carcinoma of cervix during the period from 2012–2017. The following details were recorded from the records: initial stage, histopathology, grade of the tumor, initial treatment modality, methods of urinary and fecal diversion, duration of follow-up, disease-free survival, pattern of recurrence, postoperative histopathology, postoperative morbidity and mortality and survival pattern post-LEER procedure. Totally, 15 patients were operated; among them, 13 cases were recurrent, progressive or residual disease and two cases were primary (stage IVA) cases. Among 13 cases, an initial stage was IIB in six cases and stage IIIB in seven cases. Among 15 patients, five patients received definitive chemo-radiation; eight out of 15 patients received only external beam radiation without brachytherapy. All but one case was done via laparotomy. All margins were negative in all cases. Early (30 days) postoperative mortality was seen in two patients due to urosepsis. Postoperative complications were perineal wound dehiscence (60%), surgical site infections (33%) and electrolyte abnormalities (33%). After 30 days, recurrent urosepsis and chronic renal failure were seen in 46% of patients. No significant differences between two types of diversion techniques were found. Four patients had recurrence in the pelvis and were started on palliative chemotherapy. Two of these patients died within 2 years. Distant metastasis was seen in three patients and all died within 2 years. Average follow-up was 2.9 years (range 15 months–5 years). Two-year overall survival was 53%. Two-year disease-free survival was 40%. LEER as a salvage surgery is indicated for primary and recurrent cervical cancer with disease up to pelvic side wall for improving disease-free survival. Though the operating time and blood loss are high in this mega procedure with increased perioperative mortality and morbidity, negative margin (R0) can be achieved with adequate local control and better survival.