Results of pelvic exenteration in patients with cervical cancer: clinical experience

Abstract

Background. Despite the progress in pelvic exenteration (PE) technique in international oncological practice, it is still debatable for cancer surgeons. The main reasons for its unpopularity are technical complexity, high rate of intra- and postoperative complications (60%), high postoperative mortality (30%), and challenging postoperative rehabilitation of patients.
 Aim. To evaluate long-term outcomes after pelvic exenteration in patients with locally advanced recurrent cervical cancer.
 Materials and methods. From September 2021 to December 2022, 23 PEs were performed, including 12 total and 11 anterior. The mean age was 52.2±10.0 years (range 39–83 years). All patients were diagnosed with locally advanced recurrent cervical cancer: 7 (30%) with stage II, 8 (35%) with stage III, and 8 (35%) with stage IV according to the TNM classification. Histologically, cervical cancer was represented by moderately differentiated squamous cell carcinoma. PE was preceded by the following treatments: neoadjuvant chemotherapy in 17 (74%) patients, surgical treatment in 4 (17%) patients, and chemoradiotherapy in 2 (9%) patients. More than half (56%) of patients achieved grade 2 therapeutic pathomorphism. The advanced disease involved the following adjacent organs: bladder (16; 70%), intestines (13; 56%), uterine endometrium (7; 30%), myometrium and parametrium (4; 17%), fallopian tubes, vagina, and ovary (2; 9%).
 Results. The average follow-up time for patients was 9.4±8.8 months. Median time to progression – 8.7 months [5.9; 10.8]. During the observation period, 78.3% (18/23) of patients died. Progression was recorded in 39.1% (9/23) of patients. The 1-year overall survival of patients was 38.7% (median 8.9 months). The 1-year tumor-specific survival rate was 60.6% (median 14.1 months). The 1- and 3-year progression-free survival (PFS) rates were 63.0 and 49.0% (median, 13.4 months), respectively.
 Conclusion. During the observation period, death occurred in 54.6% (12/23) of cases in the anterior PE group, and in 25% (6/23) in the total group. The median overall survival with anterior PE is 2 times higher compared to total PE (9.6 months versus 4.1 months). Median PFS was 13.4 months. For patients after anterior and total pelvic exenteration, 1-year PFS was 51.9±17.6 and 72.9±13.5; 3-year – 25.9±15.7 and 72.9±13.5 (p=0.178), respectively. Thus, PE is justified and significantly expands the possibilities of surgical treatment.