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01-05-2011 | Gynecologic Oncology

Palliative pelvic exenteration for patients with gynecological malignancies

Authors: Gustavo Cardoso Guimarães, Glauco Baiocchi, Fabio Oliveira Ferreira, Lillian Yuri Kumagai, Carlos Chaves Fallopa, Samuel Aguiar, Benedito Mauro Rossi, Fernando Augusto Soares, Ademar Lopes

Published in: Archives of Gynecology and Obstetrics | Issue 5/2011

Abstract

Purpose

To evaluate the results of palliative pelvic exenteration in patients with gynecologic tumors.

Methods

A retrospective analysis was carried out in 13 patients from January 2000 to December 2007. The procedure was considered palliative because of distant metastatic disease or unresectable pelvic wall disease. Patients presented with bleeding, fistula, malodorous discharge or untreatable pain.

Result

Overall complication rate was 38.4%. Mean follow-up time was 8 months. Actuarial 2 years overall survival was 15.4%. Six patients survived more than 5 months and three more than 12 months. All achieved symptoms control and favorable impact in quality of life. Two patients are with stable disease after 26 and 28 months.

Conclusions

Palliative exenteration is a procedure with high morbidity and mortality rates and should only be offered to highly selected patients. The role of exenterative surgery in relieving severe symptoms in patients with incurable disease is yet to be established.

Höckel M, Dornhöfer N (2006) Pelvic exenteration for gynaecological tumours: achievements and unanswered questions. Lancet Oncol 7(10):837–847PubMedCrossRef

Brunschwig A (1948) Complete excision of pelvic viscera for advanced carcinoma. Cancer 1:177–183PubMedCrossRef

Berek JS, Howe C, Lagasse LD, Hacker NF (2005) Pelvic exenteration for recurrent gynaecologic malignancy: survival and morbidity analysis of the 45-year experience at UCLA. Gynecol Oncol 99(1):1539CrossRef

Höckel M (2003) Laterally extended endopelvic resection—novel surgical treatment of locally recurrent cervical carcinoma involving the pelvic side wall. Gynecol Oncol 91:369–377PubMedCrossRef

Houvenaeghel G, Moutardier V, Karsenty G, Bladou F, Lelong B, Buttarelli M et al (2004) Major complications of urinary diversion after pelvic exenteration for gynecologic malignancies: a 23-year mono-institutional experience in 124 patients. Gynecol Oncol 92:680–683PubMedCrossRef

Ketcham AS, Deckers PJ, Sugarbaker EV, Hoye RC, Thomas LB, Smith RR (1970) Pelvic exenteration for carcinoma of the uterine cervix—a 15-year experience. Cancer 26(3):513–521PubMedCrossRef

Lawhead RA, Clark DGC, Smith DH, Pierce VK, Lewis JL (1989) Pelvic exenteration for recurrent or persistent gynaecologic malignancies: a 10-year review of the Memorial-Sloan-Kettering Cancer Center experience (1972–1981). Gynecol Oncol 33:279–282PubMedCrossRef

Magrina JF, Stanhope CR, Waever AL (1997) Pelvic exenterations: supralevator, infralevator, and with vulvectomy. Gynecol Oncol 64:130–135PubMedCrossRef

Morley GW, Hopkins MP, Lindenauer SM, Roberts JA (1989) Pelvic exenteration, university of Michigan: 100 patients at 5 years. Obstet Gynecol 74:934–943PubMed

10.

Saunders N (1995) Pelvic exenteration: by whom and for whom? Lancet 345:5–6PubMedCrossRef

11.

Sharma S, Odunsi K, Driscoll D, Lele S (2005) Pelvic exenteration for gynecological malignancies: twenty-year experience at Rosewell Park Cancer Institute. Int J Gynecol Cancer 15:475–482PubMedCrossRef

12.

Shingelton HM, Soong SJ, Gelder MS, Hatch KD, Baker VV, Austin JM (1989) Clinical and histopathologic factors predicting recurrence and survival after pelvic exenteration for cancer of the cervix. Obstet Gynecol 73:1027–1034CrossRef

13.

Stanhope CR, Symmonds RE (1985) Palliative exenteration—what, when, and why? Am J Obstet Gynecol 152:12–16PubMed

14.

Symmonds RE, Pratt JH, Webb MJ (1975) Exenterative operations: experience with 198 patients. Am J Obstet Gynecol 121(7):907–918PubMed

15.

Guimaraes GC, Ferreira FO, Rossi BM, Aguiar S Jr, Zequi SC, Bachega W, Nakagawa WT, Fonseca FP, Sarkis AS, Lopes A (2006) Double-barreled wet colostomy is a safe option for simultaneous urinary and fecal diversion. Analysis of 56 procedures from a single institution. J Surg Oncol 93(3):206–211PubMedCrossRef

16.

Lambrou NC, Pearson JM, Averette HE (2005) Pelvic exenteration of gynecologic malignancy: indications, and technical and reconstructive considerations. Surg Oncol Clin N Am 14:289–300PubMedCrossRef

17.

Rutledge FN, Smith JP, Wharton JT, O’Quinn AG (1977) Pelvic exenteration: analysis of 296 patients. Am J Obstet Gynecol 129:881–892PubMed

18.

McCahill LE, Krouse R, Chu D, Juarez G, Uman G, Ferrell B et al (2002) Indications and use of palliative surgery–results of Society of Surgical Oncology survey. Ann Surg Oncol 9:104–112PubMedCrossRef

19.

Easson A (2005) Successful surgical palliation: how do we define it, and how do we measure it? Am Coll Surg 200:117–120

20.

World Health Organization (WHO) (1990) Analgesic Ladder, Clinical Practice Guideline. No. 9, pp 41–45, http://www.who.int/cancer/palliative/en/

21.

Hofmann B, Håheim LL, Søreide JA (2005) Ethics of palliative surgery in patients with cancer. Br J Surg 92(7):802–809PubMedCrossRef

22.

Dunn GP (2002) Surgical palliation in advanced disease: recent developments. Curr Oncol Rep 4:233–241PubMedCrossRef

23.

McCahill LE, Smith DD, Borneman T, Juarez G, Cullinane C, Chu DZJ (2003) A prospective evaluation of palliative outcomes for surgery of advanced malignancies. Ann Surg Oncol 10:654–663PubMedCrossRef

24.

Miner TJ, Jaques DP, Tavaf-Motamen H, Shriver C (1999) Decision making on surgical palliation based on patient outcome data. Am J Surg 177(2):150–154PubMedCrossRef

25.

Marnitz S, Kohler C, Muller M et al (2006) Indications for primary and secondary exenterations in patients with cervical cancer. Gynecol Oncol 103:1023–1030PubMedCrossRef

26.

Long HJ, Bundy BN, Grendys EC Jr, Benda JA, McMeekin DS, Sorosky J et al (2005) Randomized phase III trial of cisplatin with or without topotecan in carcinoma of the uterine cervix: a Gynecologic Oncology Group study. J Clin Oncol 23:4626–4633PubMedCrossRef

27.

Moore DH, Blessing JA, McQuellon RP, Thaler HT, Cella D, Benda J et al (2004) Phase III study of cisplatin with or without paclitaxel in stage IVB, recurrent, or persistent squamous cell carcinoma of the cervix: a Gynecologic Oncology Group study. J Clin Oncol 22(15):3113–3119PubMedCrossRef

28.

Tambaro R, Scambia G, DiMaio M, Pisano C, Barletta E, Iaffaioli VR, Pignata S (2004) The role of chemotherapy in locally advanced, metastatic and recurrent cervical cancer. Crit Rev Oncol Hematol 52:33–44PubMed

29.

Tinker AV, Bhagat K, Swenerton KD, Hoskins PJ (2005) Carboplatin and paclitaxel for advanced and recurrent cervical carcinoma: the British Columbia Cancer Agency experience. Gynecol Oncol 98:54–58PubMedCrossRef

30.

Beachamp TL, Childress JF (2001) Principles of biomedical ethics. Oxford University Press, New York

Title: Palliative pelvic exenteration for patients with gynecological malignancies
Authors: Gustavo Cardoso Guimarães
Glauco Baiocchi
Fabio Oliveira Ferreira
Lillian Yuri Kumagai
Carlos Chaves Fallopa
Samuel Aguiar
Benedito Mauro Rossi
Fernando Augusto Soares
Ademar Lopes
Publication date: 01-05-2011
Publisher: Springer-Verlag
Published in: Archives of Gynecology and Obstetrics / Issue 5/2011
Print ISSN: 0932-0067
Electronic ISSN: 1432-0711
DOI: https://doi.org/10.1007/s00404-010-1544-8

At a glance: The ONWARDS insulin icodec trials

Springer Medicine

Palliative pelvic exenteration for patients with gynecological malignancies

Abstract

Purpose

Methods

Result

Conclusions

At a glance: The ONWARDS insulin icodec trials

Springer Medicine

Abstract

Purpose

Methods

Result

Conclusions

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