Oncologic outcomes of pelvic exenteration for stage IVA cervical cancer: A rarely utilized treatment modality (528)

Abstract

<b>Objectives:</b> To investigate the outcomes of pelvic exenteration for patients with FIGO stage IVA cervical carcinoma. <b>Methods:</b> Patients diagnosed between 2004 and 2015 with FIGO 2009 stage IVA squamous cell, adenocarcinoma, or adenosquamous cervical carcinoma with no history of another tumor were selected from the National Cancer Database. Patients who received definitive chemoradiation (defined as external beam radiation therapy of at least 45 Gy, with concurrent chemotherapy) with no other surgical procedure and those who underwent primary pelvic exenteration with negative surgical margins were identified. Clinical-pathologic and demographic characteristics were compared. Overall survival was compared following 1:1 propensity score matching for the year of diagnosis, patient age, comorbid conditions, patient race, and insurance status. <b>Results:</b> A total of 64 patients who underwent pelvic exenteration and had negative margins were identified. The comparison group included 1176 patients who had definitive chemoradiation and did not undergo any surgical procedure. There was no statistically significant difference between the two groups in terms of patient age, race, and presence of comorbid conditions. However, patients who underwent exenteration were more likely to have private insurance (59.4% vs 34.4%, p<0.001). For patients who underwent exenteration, the unplanned re-admission rate was 11.5%, while median hospital stay was 11.5 days and 90-day mortality was 3.3%. The majority also received radiation therapy (85.9%). Following propensity score matching, patients who underwent pelvic exenteration had better OS (5-yr OS rate: 48.1%, median OS: 43.96 months) compared to those who had chemoradiation (5-yr OS rate: 16.5%, median OS: 18.63 months). <b>Conclusions:</b> Pelvic exenteration is rarely utilized in the management of patients with stage IVA cervical cancer. For carefully selected patients, overall survival may be superior to primary chemoradiation.