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Open Access 01-12-2019 | Radiotherapy | Original Article

Pelvic exenteration in gynecologic cancer: complications and oncological outcome

Authors: Víctor Lago, Ines Poveda, Pablo Padilla-Iserte, Eduardo Simón-Sanz, Álvaro García-Granero, Jose Luis Pontones, Luis Matute, Santiago Domingo

Published in: Gynecological Surgery | Issue 1/2019

Abstract

Introduction

Pelvic exenteration (PE) is indicated in cases of unresponsive, recurrent pelvic cancer or for palliative intent. Despite the fact that the surgery is associated with a high rate of morbidity, it is currently the only real option that can effect a cure.

Material and methods

Patients who underwent PE between January 2011 and July 2017 in our centre were retrospectively reviewed. Data related to surgery, complications and outcomes were recorded.

Results

Twenty-three patients were included. PE was performed due to recurrent gynaecological cancer, persistence of disease and after first diagnosis in 19 (82%), 2 (9%) and 2 patients (9%), respectively. Total PE was performed in 15 cases (65%), followed by anterior PE in 5 cases (22%) and posterior PE in 3 cases (13%). Early grade II, III and IV complications occurred in 15 (65%), 5 (22%) and 2 patients (9%), respectively. No mortality was observed within 30 days. Medium-late grade II, III, IV and V complications occurred in 15 (65%), 11 (48%), 3 (13%) and 2 cases (9%), respectively. Two patients died after > 30-day period from surgery-related complications. The overall survival (OS) and disease-free survival (DFS) at 48 months after PE was 41.6% and 30.8% respectively.

Conclusions

PE provides about a 40% 4-year survival chance in a selected group of patients. The early-complications rate and 30-day mortality were acceptable. Nevertheless, the medium-late complication grades II–V were 65, 48, 18 and 9%, respectively. We must focus on identifying those patients who could potentially benefit most from PE.

Westin SN, Rallapali V, Fellman B, Urbauer DL, Pal N, Frumovitz MM et al (2014) Overall survival after pelvic exenteration for gynecologic malignancy. Gynecol Oncol 134(3):546–551CrossRef

Fleisch MC, Pantke P, Beckmann MW, Schnuerch HG, Ackermann R, Grimm MO et al (2007) Predictors for long term survival after interdisciplinary surgery for advanced or recurrent gynecologic cancers. J Surg Oncol 95(6):474–484CrossRef

Devulapalli C, Jia Wei AT, DiBiagio J, Baez MI, Baltodano PA, Seal SM et al (2016) Primary versus flap closure of perineal defects following oncological resection. Plast Reconstr Surg 137:1602CrossRef

Dessole M, Petrillo M, Lucidi A, Naldini A, Rossi M, De Iaco P et al (2018) Quality of life in women after pelvic exenteration for gynecological malignancies: a multicentric study. Int J Gynecol Cancer 28(2):267–273CrossRef

Magrina JF (1990) Types of pelvic exenterations: a reappraisal. Gynecol Oncol 37(3):363–366CrossRef

Dindo D, Demartines N, Clavien PA (2004) Classification of surgical complications: a new proposal with evaluation in a cohort of 6336 patients and results of a survey. Ann Surg 240:205–213CrossRef

Moreno-Palacios E, Diestro MD, De Santiago J, Hernández A, Zapardiel I (2015) Pelvic exenteration in gynecologic cancer: La Paz University hospital experience. Int J Gynecol Cancer 25:1109–1114CrossRef

Jäger L, Nilsson PJ, Rådestad AF (2013) Pelvic exenteration for recurrent gynecologic malignancy: a study of 28 consecutive patients at a single institution. Int J Gynecol Cancer 23:755–762CrossRef

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

10.

Bhangu A, Beynon J, Brown G, Chang G, Das P, Desai A et al (2013) Consensus statement on the multidisciplinary management of patients with recurrent and primary rectal cancer beyond total mesorectal excision planes. Br J Surg 100(8):E1–33

11.

Höckel M (2008) Laterally extended endopelvic resection (LEER)—principles and practice. Gynecol Oncol 111(2 Suppl):S13–S17CrossRef

12.

Petruzziello A, Kondo W, Hatschback SB, Guerreiro JA, Filho FP, Vendrame C et al (2014) Surgical results of pelvic exenteration in the treatment of gynecologic cancer. World J Surg Oncol 12:279CrossRef

13.

Maggioni A, Zanagnolo V, Peiretti M, Colombo N et al (2009) Pelvic exenteration: ten-year experience at the European Institute of Oncology in Milan. Gynecol Oncol 114(1):64–68CrossRef

14.

Kaur M, Joniau S, D'Hoore A, Van Calster B, Van Limbergen E, Leunen K et al (2012) Pelvic exenterations for gynecological malignancies: a study of 36 cases. Int J Gynecol Cancer 22:889–896CrossRef

15.

Chiantera V, Rossi M, De Iaco P, Koehler C, Marnitz S, Ferrandina G et al (2014) Survival after curative pelvic exenteration for primary or recurrent cervical cancer: a retrospective multicentric study of 167 patients. Int J Gynecol Cancer 24(5):916–922CrossRef

16.

Van Wijk FH, van der Burg ME, Burger CW, Vergote I, van Doorn HC (2009) Management of recurrent endometrioid endometrial carcinoma: an overview. Int J Gynecol Cancer 19:314–320CrossRef

17.

Brunschwig A (1948l) Complete excision of pelvic viscera for advanced carcinoma; a one-stage abdominoperineal operation with end colostomy and bilateral ureteral implantation into the colon above the colostomy. Cancer 1:177–183CrossRef

18.

Brophy PF, Hoffman JP, Eisenberg BL (1994) The role of palliative pelvic exenteration. Am J Surg 167:386–390CrossRef

19.

Guimarães GC, Baiocchi G, Ferreira FO, Kumagai LY, Fallopa CC, Aguiar S et al (2011) Palliative pelvic exenteration for patients with gynecological malignancies. Arch Gynecol Obstet 283:1107–1112CrossRef

20.

Seagle BL, 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 143:472–478CrossRef

21.

Husain A, Curtin J, Brown C, Chi D, Hoskins W, Poynor E et al (2000) Continent urinary diversion and low-rectal anastomosis in patients undergoing exenterative procedures for recurrent gynecologic malignancies. Gynecol Oncol 78:208–211CrossRef

22.

Urh A, Soliman PT, Schmeler KM, Westin S, Frumovitz M, Nick AM et al (2013) Postoperative outcomes after continent versus incontinent urinary diversion at the time of pelvic exenteration for gynecologic malignancies. Gynecol Oncol 129:580–585CrossRef

23.

Hautmann RE, Hautmann SH, Hautmann O (2011) Complications associated with urinary diversion. Nat Rev Urol 8:667–677CrossRef

24.

Villa M, Saint-Cyr M, Wong C, Butler CE (2011 Jan) Extended vertical rectus abdominis myocutaneous flap for pelvic reconstruction: three-dimensional and four-dimensional computed tomography angiographic perfusion study and clinical outcome analysis. Plast Reconstr Surg 127(1):200–209CrossRef

25.

Campbell CA, Butler CE (2011 Aug) Use of adjuvant techniques improves surgical outcomes of complex vertical rectus abdominis myocutaneous flap reconstructions of pelvic cancer defects. Plast Reconstr Surg 128(2):447–458CrossRef

26.

Milne t S mJ, lee P, Jm Y, Stalley P, Harrison JD (2013) Assessing the impact of a sacral resection on morbidity and survival after extended radical surgery for locally recurrent rectal cancer. Ann Surg 258:1007–1013CrossRef

27.

Dobrowsky W, Schmid AP (1985) Radiotherapy of presacral recurrence following radical surgery for rectal carcinoma. Dis Colon Rectum 28:917–919.1CrossRef

28.

Milne t S mJ, Lee P, Young JM, Stalley P, Harrison JD et al (2014) Sacral resection with pelvic exenteration for advanced primary and recurrent pelvic cancer: a single-institution experience of 100 sacrectomies. Dis Colon Rectum 57:1153–1161CrossRef

29.

Solomon MJ, Tan KK, Bromilow RG, Al-mozany N, Lee PJ (2014) Sacrectomy via the abdominal approach during pelvic exenteration. Dis Colon Rectum 57:272–277CrossRef

30.

Solomon MJ, Austin KK, Masya L, Lee P (2015) Pubic bone excision and perineal urethrectomy for radical anterior compartment excision during pelvic exenteration. Dis Colon Rectum 58:1114–1119CrossRef

Title: Pelvic exenteration in gynecologic cancer: complications and oncological outcome
Authors: Víctor Lago
Ines Poveda
Pablo Padilla-Iserte
Eduardo Simón-Sanz
Álvaro García-Granero
Jose Luis Pontones
Luis Matute
Santiago Domingo
Publication date: 01-12-2019
Publisher: Springer Berlin Heidelberg
Keyword: Radiotherapy
Published in: Gynecological Surgery / Issue 1/2019
Print ISSN: 1613-2076
Electronic ISSN: 1613-2084
DOI: https://doi.org/10.1186/s10397-019-1055-y

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Pelvic exenteration in gynecologic cancer: complications and oncological outcome

Abstract

Introduction

Material and methods

Results

Conclusions

Keynote webinar | Spotlight on sleep in brain health

Springer Medicine

Abstract

Introduction

Material and methods

Results

Conclusions

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