Pelvic Exenterations for Gynecological Malignancies

Abstract

Evaluation of surgical outcomes, survival, and morbidity associated with pelvic exenteration (PE) performed for gynecologic malignancies. Review of 36 consecutive patients who underwent PE between June 1999 and April 2010. Pelvic exenteration was performed for cancer of the cervix (n = 18), endometrium (n = 9), vagina/vulva (n = 8), and ovary (n = 1). Four patients underwent PE as primary treatment and 32 patients for recurrent disease after pelvic radiotherapy. Median age was 57 years (range, 35-81 years). Bricker (n = 17), Mainz pouch (n = 10), and augmentation after bladder resection (n = 6) were used as urinary derivations. J-pouch coloanal anastomosis was performed in 14, colostomy in 13, and side-to-end anastomosis in 4 patients. There was no operative mortality. The most important postoperative complications were rectovaginal fistula (5), urinary leakage (2), vesicovaginal fistula (1), and sepsis (3). One of the 6 patients with a partial cystectomy developed a vesicovaginal fistula, which was successfully treated with a Martius flap. With a median follow-up of 78 months (range, 2-131) months, the 5-year overall and disease-specific survival (DSS) rates were 44% and 52%, respectively. Five-year DSS for cervical, endometrial, and vaginal/vulvar cancer was 44%, 80%, and 57%, respectively. Combined operative and radiotherapeutic treatment (CORT) was performed in 3 patients with pelvic side wall relapse. Of the 15 patients 65 years or older, a 5-year DSS of 71% was observed in comparison with 42% in the younger subgroup, and their complication rates were similar to the younger patient group. Thirteen patients (36%) reported to have psychological disturbances associated with stoma-related problems. Only 3 patients requested a vaginal reconstruction during follow-up. Pelvic exenteration offers a sustained survival with an acceptable morbidity in patients with advanced or recurrent gynecologic cancer. Older age was not associated with higher morbidity/mortality in this series.