Pelvic exenterations for gynecologic malignancies: 20-year experience at a cancer institute

Abstract

5138 Background: Pelvic exenterations have undergone multiple modifications since originally described 55 years ago. Most common indication is centrally recurrent or persistent cancer of the cervix after radiation therapy. The goal of this study is to retrospectively review gynecologic patients that have undergone pelvic exenterations at a single cancer institution. Methods: All women that underwent a pelvic exenteration for a gynecologic malignancy between January 1980 and December 1999 were reviewed. 48 patients were reviewed by organ, histology, stage and type of exenteration. Outcomes reviewed were the early and late postoperative complications (< 30 or > 30 days of surgery), need for reoperation, recurrence of tumor, survival, disease free interval, and life after pelvic exenteration. Variables were analyzed by the log-rank test and Kaplan-Meier curves. Results: 48 patients (ages 21–78) underwent pelvic exenterations for cervical (39), vulvar (3), endometrial (2), ovarian (2), and vaginal (2) cancers. 41 underwent total exenteration, 6 anterior, and 1 posterior. Majority of patients (45) had received prior radiation therapy. The median survival was 35 months and the disease free survival was 32 months. Mortality from the procedure was 4.2%. Early and late postoperative complication rates were 27% and 75% respectively. Recurrence rate was 48%; majority of recurrences were in the pelvis (50%). 8 patients received intraoperative radiation. Univariate analysis failed to show an association between type of pelvic exenteration, type of fecal and urinary diversion, outcome, need for reoperation, and recurrence. Conclusions: Contemporary pelvic exenterations are associated with a low mortality and potential for long-term survival in a subset of patients that historically have been given a poor prognosis. In patients with recurrent gynecological cancer confined centrally to the pelvis, pelvic exenteration still remains the choice of therapy as response to chemotherapy to a centrally recurrent tumor in radiated area continues to be poor. Intra-operative radiation in select few patients needs to be further studied. Author Disclosure Employment or Leadership Consultant or Advisory Stock Ownership Honoraria Research Funding Expert Testimony Other Remuneration GlaxoSmithKline