Abstract
<strong>INTRODUCTION:</strong> The prognosis of patients with persistent or recurrent cervical cancer (CC) is poor, and patient selection for exenterative surgery is challenging. The aim of this study was to determine the outcomes of patients undergoing pelvic exenteration (PE) for persistent or recurrent CC after treatment with radiotherapy in Belarus. <strong>METHODS:</strong> A retrospective study was performed of 22 patients with persistent and recurrent CC who underwent supralevator PE from 2006 to 2012 at NN Alexandrov National Cancer Centre. Anterior PE was performed in 16 (72.7%) patients, posterior PE in 2 (9.1%) and total PE in 4 (18.2%) patients. <strong>RESULTS:</strong> The mean surgical procedure time was 289.1 minutes. Urinary diversion was performed in 20 patients: 5 (25.0%) underwent ureterostomy and 15 (75.0%) underwent neobladder formation. Fecal diversion with end colostomy (Hartman’s procedure) was performed in 5 patients and in one patient a rectosigmoid resection with anastomosis was performed. The median follow-up time was 87 months (range, 4.4–146.0 months). To date, 16 (72.7%) patients have died of cervical cancer and there were no deaths due to other causes. The median survival was 17 months with a 5-year survival rate of 31.8% (SE 9.9%). Cox regression analysis showed that surgical margin status and pelvic lymph node involvement were independent risk factors for survival. <strong>CONCLUSIONS:</strong> PE was found to be a safe and feasible option for patients with persistent or recurrent cervical cancer who do not have other potentially curative treatment options. Careful patient selection is needed to determine which patients will benefit from this treatment. <strong>HIGHLIGHTS:</strong> <ul><li>Treatment options are limited for patients with persistent or recurrent cervical cancer</li><li>Pelvic exenteration is a safe and feasible option for women in Belarus</li><li>Positive surgical margins and positive lymph node status are risk factors affecting survival</li></ul>
Highlights
The prognosis of patients with persistent or recurrent cervical cancer (CC) is poor, and patient selection for exenterative surgery is challenging
Cox regression analysis showed that surgical margin status and pelvic lymph node involvement were independent risk factors for survival
Treatment options are limited for patients with persistent or recurrent cervical cancer
Summary
The prognosis of patients with persistent or recurrent cervical cancer (CC) is poor, and patient selection for exenterative surgery is challenging. Relapses that occur most often involve the surrounding organs and pelvic tissues, which leads to the need to simultaneously remove the bladder and/ or rectum along with the recurrent tumor en bloc. Considerable experience has been gained in performing PE with the continuous improvement of surgical techniques, and in refining the indications and patient selection for the procedure. It is currently recommended in women with recurrent or persistent cervical cancer in the central pelvis following radiation therapy and without evidence of metastatic disease [1]
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