Outcome of pelvic exenteration for recurrent endometrial and cervical cancers.

Abstract

e15524 Background: Pelvic exenteration has been used as a potentially curative operation in recurrent pelvic malignancies. However, treatment-related morbidity is over 50% in radiated pelves. We evaluated the outcome and the morbidity of pelvic exenteration in women with recurrent cervical and endometrial cancer. Methods: We studied retrospectively all the patients who underwent a pelvic exenteration for recurrent cervical or endometrial cancer in our institution, from January 1999 to November 2011. All medical data were collected. Survival rates were calculated according to Kaplan-Meier method and compared using the log-rank test. Results: twenty-five patients were identified, 17 (68%) had cervical cancer and 8 (32%) endometrial cancer. All patients received a radiation therapy during their initial treatment. All patients had a central pelvic recurrence, in a median time of 30 months [4-384]. 15 patients (60%) had an urinary diversion with incontinent ileoconduit (Bricker). 22 patients (88%) had a complete tumor resection. Severe early complications needing a re-laparotomy occurred in 9 patients (36%) (insufficiencies of intestinal anastomosis, insufficiencies of the ureteral anastomosis and pelvic abscesses). One patient (4%) had a recto-vaginal fistula. Late complications included 1 (4%) vaginal fistula, 1 (4%) intestinal fistula), 2 (8%) intestinal occlusion and 1 (4%) ureteral stenosis. Disease Free and Overall survival rates are better in cervical than in endometrial cancer (median DFS in months 17 [2-145] vs 9.5 [3-21], p= 0.064, median OS in months 20 [2-145] vs 13 [4-42], p=0.019) (table 1). Conclusions: Morbidity of pelvic exenteration remains high. Endometrial cancer is associated with a poorer prognosis. In those patients, the benefit of exenteration should be discussed compared to best supportive care for palliative treatment. [Table: see text]