Outcomes of perisurgery and short-time follow-up of pelvic exenteration for 17 cases with locally recurrent cervical cancer

Abstract

Objective: To investigate the perioperative situation and recent effect of pelvic exenteration for patients with locally recurrent cervical cancer. Methods: A total of 17 patients with locally recurrent cervical cancer who underwent pelvic exenteration in Peking University People's Hospital from October 2015 to May 2018 were retrospectively analyzed for their clinical and pathological characteristics, surgical conditions, hospitalization costs, postoperative complications, and survival situation. Results: (1) The median age of 17 patients with locally recurrent cervical cancer was 51 years (range 27-64 years). Pathological type: 13 cases of squamous cell carcinoma, 2 cases of adenocarcinoma, and 2 cases of adenosquamous carcinoma. Thirteen patients received radiotherapy during the initial treatment and 4 patients did not receive radiotherapy. (2) Pelvic exenteration was performed in 17 patients with locally recurrent cervical cancer, of which 9 cases were performed with total pelvic exenteration (operation range including radical cystectomy, partial urethrectomy rectectomy and partial vaginalectomy), and 8 cases with anterior pelvic exenteration operation (operation range including: radical cystectomy, part of urethrectomy and part of vaginalectomy). Of the 17 patients successfully completed the operation. The median operation time was 450 minutes (range 240-760 minutes), the median intraoperative blood loss was 2 200 ml (range 200- 8 400 ml), the median postoperative hospital stay was 17 days (range 9-55 days), the median hospital cost was 83 857 yuan (range 41 588-296 354 yuan). (3) Of the 17 patients underwent pelvic exenteration, 16 of them had early complications, the most common one was fever (14 cases). Fourteen of them had late complications, and the most common one was a urinary system infection (12 cases). (4) The median overall survival time was 26.0 months (range 3-44 months), the median progression-free survival (PFS) time was 9.0 months (range 2-44 months). Among them, 13 patients received radiation therapy during the initial treatment, the median PFS time was 9.0 months (range 2-30 months); 4 patients did not receive radiation therapy in the initial treatment, the median PFS time was 10.5 months (range 2-44 months).Eleven patients received adjuvant therapy after pelvic exenteration, the median PFS time was 12.0 months (range 2-44 months); 6 patients did not receive adjuvant therapy, the median PFS time was 5.0 months (range 2-9 months). Conclusions: Pelvic exenteration has a wide range of operations, many postoperative complications, and high hospitalization costs. Adjuvant treatment after pelvic exenteration could improve the PFS time for some patients. Its clinical value and health economic value need to be further explored.