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Surgeons Corner
Pelvic Exenterations for Gynecological Malignancies: A Study of 36 Cases
  1. Manpreet Kaur, MD*,
  2. Steven Joniau, MD†,
  3. André D’Hoore, MD, PhD‡,
  4. Ben Van Calster, PhD§,
  5. Erik Van Limbergen, MD, PhD∥,
  6. Karin Leunen, MD, PhD*,
  7. Freddy Penninckx, MD, PhD‡,
  8. Hendrik Van Poppel, MD, PhD†,
  9. Frederic Amant, MD, PhD* and
  10. Ignace Vergote, MD, PhD*
  1. *Division of Gynaecological Oncology, Department of Obstetrics and Gynaecology, and Leuven Cancer Institute, University Hospitals of Leuven; Departments of
  2. †Urology,
  3. ‡Abdominal Surgery, and
  4. §Obstetrics and Gynecology and Leuven Cancer Institute, University Hospitals, KU Leuven; and
  5. ∥Department of Radiotherapy-Oncology, University Hospitals of Leuven, Belgium.
  1. Address correspondence and reprint requests to Ignace Vergote, MD, PhD, Division of Gynaecological Oncology, University Hospitals of Leuven, Herestraat 49, 3000 Leuven, Belgium, European Union. E-mail: Ignace.Vergote@uzleuven.be.

Abstract

Objective Evaluation of surgical outcomes, survival, and morbidity associated with pelvic exenteration (PE) performed for gynecologic malignancies.

Methods Review of 36 consecutive patients who underwent PE between June 1999 and April 2010.

Results 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.

Conclusions 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.

  • Pelvic exenteration
  • Gynecological malignancies
  • Surgery
  • Survival
  • Complications
  • Radiotherapy
  • CORT

https://doi.org/10.1097/IGC.0b013e31824eb8cd

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    Footnotes

    • The author declares that there is no conflicts of interest.