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Archives of Gynecology and Obstetrics

, Volume 300, Issue 1, pp 161–168 | Cite as

Pelvic exenteration as ultimate ratio for gynecologic cancers: single-center analyses of 37 cases

  • N. de GregorioEmail author
  • A. de Gregorio
  • F. Ebner
  • T. W. P. Friedl
  • J. Huober
  • R. Hefty
  • M. Wittau
  • W. Janni
  • P. Widschwendter
Gynecologic Oncology
  • 44 Downloads

Abstract

Background

Pelvic exenterations are a last resort procedure for advanced gynecologic malignancies with elevated risks in terms of patients’ morbidity.

Methods

This single-center analysis reports surgical details, outcome and survival of all patients treated with exenteration for non-ovarian gynecologic malignancies at our university hospital during a 13-year time period. We collected data regarding patients and tumor characteristics, surgical procedures, peri- and postoperative management, transfusions, complications, and analyzed the impact on survival outcomes.

Results

We identified 37 patients between 2005 and 2013 with primary or relapsed cervical cancer (59.5%), vulvar cancer (24.3%) or endometrial cancer (16.2%). Median age was 60 years and most patients (73%) had squamous cell carcinomas. Median progression-free survival was 26.2 months and median overall survival was 49.9 months. The 5-year survival rates were 34.4% for progression-free survival and 46.4% for overall survival. There were no significant differences in progression-free survival and overall survival with regard to disease entity. Patients with tumor at the resection margins (R1) had a nearly significantly worse progression-free survival (median: 28.5 vs. 7.3 months, HR 2.59, 95% CI 0.98–6.88, p = 0.056) and a significantly worse overall survival (median: not reached vs. 10.9 months, HR 4.04, 95% CI 1.40–11.64, p = 0.010) compared to patients with complete tumor resection (R0). In addition, patients without lymphovascular space invasion had a significantly better progression-free survival (p = 0.017) and overall survival (p = 0.034) then patients with lymphovascular space invasion. We observed complications in 14 patients (37.8%), 10 of those were classified as Clavien–Dindo 3 or 4. There was a trend to worse progression-free survival in patients that suffered complications (p = 0.052). Median total amount of transfused blood products was 4 (range 0–20).

Conclusion

Pelvic exenteration is a procedure that provides substantial progression-free survival and overall survival improvement and—in selected patients—can even achieve cure in otherwise hopeless clinical situations. Patients need to be offered earnest counseling for sufficient informed consent with realistic expectations what to expect.

Keywords

Pelvic exenteration Advanced gynecologic malignancy Cervical cancer Endometrial cancer Vulvar cancer 

Notes

Author contributions

NdeG: conceptualization and writing original draft. AdeG: resources, review and editing. FEbner: review and editing. TWPF: data curation and formal analysis. JH: supporting and review. RH and MW: resources and review. WJ: supervision and review. PW: conceptualization, resources, review and editing.

Compliance with ethical standards

Conflict of interest

We have no potential conflict of interest.

Ethical approval

This study was approved by local ethics committee.

References

  1. 1.
    Höckel M, Horn L-C, Einenkel J (2012) (Laterally) extended endopelvic resection: surgical treatment of locally advanced and recurrent cancer of the uterine cervix and vagina based on ontogenetic anatomy. Gynecol Oncol 127(2):297–302.  https://doi.org/10.1016/j.ygyno.2012.07.120 CrossRefGoogle Scholar
  2. 2.
    Höckel M, Dornhöfer N (2006) Pelvic exenteration for gynaecological tumours: achievements and unanswered questions. Lancet Oncol. 7(10):837–847.  https://doi.org/10.1016/S1470-2045(06)70903-2 CrossRefGoogle Scholar
  3. 3.
    Martinez A, Filleron T, Rouanet P et al (2018) Prospective assessment of first-year quality of life after pelvic exenteration for gynecologic malignancy: a French multicentric study. Ann Surg Oncol 25(2):535–541.  https://doi.org/10.1245/s10434-017-6120-z CrossRefGoogle Scholar
  4. 4.
    Jäger L, Nilsson PJ, Rådestad AF (2013) Pelvic exenteration for recurrent gynecologic malignancy. Int J Gynecol Cancer. 23(4):755–762.  https://doi.org/10.1097/IGC.0b013e318287a874 CrossRefGoogle Scholar
  5. 5.
    Katory M, McLean R, Paez E, Kucukmetin A, Naik R (2017) Short- and long-term outcomes following pelvic exenteration for gynae-oncological and colorectal cancers: a 9 year consecutive single-centre cohort study. Int J Surg. 43:38–45.  https://doi.org/10.1016/j.ijsu.2017.05.037 CrossRefGoogle Scholar
  6. 6.
    Clavien PA, Barkun J, de Oliveira ML et al (2009) The Clavien–Dindo classification of surgical complications: five-year experience. Ann Surg 250(2):187–196.  https://doi.org/10.1097/SLA.0b013e3181b13ca2 CrossRefGoogle Scholar
  7. 7.
    Moore DH, Tian C, Monk BJ, Long HJ, Omura GA, Bloss JD (2010) Prognostic factors for response to cisplatin-based chemotherapy in advanced cervical carcinoma: a Gynecologic Oncology Group Study. Gynecol Oncol 116(1):44–49.  https://doi.org/10.1016/j.ygyno.2009.09.006 CrossRefGoogle Scholar
  8. 8.
    Donati OF, Lakhman Y, Sala E et al (2013) Role of preoperative MR imaging in the evaluation of patients with persistent or recurrent gynaecological malignancies before pelvic exenteration. Eur Radiol 23(10):2906–2915.  https://doi.org/10.1007/s00330-013-2875-1 CrossRefGoogle Scholar
  9. 9.
    Burger IA, Vargas HA, Donati OF et al (2013) The value of 18F-FDG PET/CT in recurrent gynecologic malignancies prior to pelvic exenteration. Gynecol Oncol 129(3):586–592.  https://doi.org/10.1016/j.ygyno.2013.01.017 CrossRefGoogle Scholar
  10. 10.
    Seagle B-LL, Dayno M, Strohl AE, Graves S, Nieves-Neira W, Shahabi S (2016) Survival after pelvic exenteration for uterine malignancy: a National Cancer Data Base study. Gynecol Oncol. 143(3):472–478.  https://doi.org/10.1016/j.ygyno.2016.10.018 CrossRefGoogle Scholar
  11. 11.
    Kaur M, Joniau S, D’Hoore A et al (2012) Pelvic exenterations for gynecological malignancies. Int J Gynecol Cancer. 22(5):889–896.  https://doi.org/10.1097/IGC.0b013e31824eb8cd CrossRefGoogle Scholar
  12. 12.
    Chiantera V, Rossi M, De Iaco P et al (2014) Morbidity after pelvic exenteration for gynecological malignancies: a retrospective multicentric study of 230 patients. Int J Gynecol Cancer. 24(1):156–164.  https://doi.org/10.1097/IGC.0000000000000011 CrossRefGoogle Scholar
  13. 13.
    Berek JS, Howe C, Lagasse LD, Hacker NF (2005) Pelvic exenteration for recurrent gynecologic malignancy: survival and morbidity analysis of the 45-year experience at UCLA. Gynecol Oncol 99(1):153–159.  https://doi.org/10.1016/j.ygyno.2005.05.034 CrossRefGoogle Scholar
  14. 14.
    Roos EJ, Van Eijkeren MA, Boon TA, Heintz AP (2005) Pelvic exenteration as treatment of recurrent or advanced gynecologic and urologic cancer. Int J Gynecol Cancer. 15(4):624–629.  https://doi.org/10.1111/j.1525-1438.2005.00118.x CrossRefGoogle Scholar
  15. 15.
    Kanao H, Aoki Y, Hisa T, Takeshima N (2018) Laparoscopic laterally extended endopelvic resection (LEER) for cervical carcinoma recurring at the pelvic sidewall after concurrent chemoradiotherapy: our experience in three cases. Gynecol Oncol 149(2):428–429.  https://doi.org/10.1016/j.ygyno.2018.02.002 CrossRefGoogle Scholar
  16. 16.
    Westin SN, Rallapalli V, Fellman B et al (2014) Overall survival after pelvic exenteration for gynecologic malignancy. Gynecol Oncol 134(3):546–551.  https://doi.org/10.1016/j.ygyno.2014.06.034 CrossRefGoogle Scholar
  17. 17.
    Goldberg GL, Sukumvanich P, Einstein MH, Smith HO, Anderson PS, Fields AL (2006) Total pelvic exenteration: the Albert Einstein College of Medicine/Montefiore Medical Center Experience (1987 to 2003). Gynecol Oncol 101(2):261–268.  https://doi.org/10.1016/j.ygyno.2005.10.011 CrossRefGoogle Scholar
  18. 18.
    Höckel M (1999) Pelvic recurrences of cervical cancer. Relapse pattern, prognostic factors and the role of extended radical treatment. J Pelvic Surg. 5:255–266Google Scholar
  19. 19.
    MacLaughlan David S, Marjon N, English D, Purington N, Han SS, Dizon DS (2018) Palliative total pelvic exenteration for gynecologic cancers. Int J Gynecol Cancer. 28(9):1.  https://doi.org/10.1097/IGC.0000000000001371 CrossRefGoogle Scholar

Copyright information

© Springer-Verlag GmbH Germany, part of Springer Nature 2019

Authors and Affiliations

  1. 1.Department of Obstetrics and GynecologyUniversity of UlmUlmGermany
  2. 2.Department of Obstetrics and GynecologyAmper Hospital DachauDachauGermany
  3. 3.Department of UrologyKlinikum HeidenheimHeidenheim an der BrenzGermany
  4. 4.Department of General SurgeryUniversity of UlmUlmGermany

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