Anterior pelvic exenteration with total vaginectomy for recurrent or persistent genitourinary malignancies: Review of surgical technique, complications, and outcome

• Published in: Gynecologic oncology 2012-09, Vol.126 (3), p.346-350
• Main Authors: Andikyan, V, Khoury-Collado, F, Gerst, S.R, Talukdar, S, Bochner, B.H, Sandhu, J.S, Abu-Rustum, N, Sonoda, Y, Barakat, R.R, Chi, D.S
• Format: Article
• Language: English
• Subjects: Adenocarcinoma - pathology; Adenocarcinoma - surgery; Adult; Aged; Anterior pelvic exenteration; Blood Loss, Surgical; Blood Transfusion; Carcinoma, Squamous Cell - pathology; Carcinoma, Squamous Cell - surgery; Chemotherapy, Adjuvant; Complication; Feasibility; Female; Hematology, Oncology and Palliative Medicine; Humans; Middle Aged; Neoplasm Recurrence, Local - surgery; Obstetrics and Gynecology; Outcome; Patient Readmission; Pelvic Exenteration - adverse effects; Pelvic Exenteration - methods; Radiotherapy, Adjuvant; Retrospective Studies; Time Factors; Total vaginectomy; Urogenital Neoplasms - pathology; Urogenital Neoplasms - surgery; Vagina - surgery
• ISSN: 0090-8258; 1095-6859
• DOI: 10.1016/j.ygyno.2012.04.034

Abstract Objective To describe the surgical technique, complications, and outcomes after anterior pelvic exenteration with total vaginectomy (AETV) for recurrent or persistent genitourinary malignancies. Methods We reviewed the medical records of all patients who underwent AETV between 12/2002 and 07/2011. Relevant demographic, clinical, and pathological information was collected. Postoperative complications and rates of readmission and reoperation (up to 180 days after surgery) were examined, and preliminary survival data were obtained. Results We identified 11 patients who underwent AETV. The median age at the time of the surgery was 55 years (range, 36–71). The median tumor size was 0.9 cm (range, microscopic — 4). Primary tumor sites included: cervix, 6; uterus, 3; vagina, 1; and urethra, 1. Complete surgical resection with negative pathologic margins was achieved in all 11 patients. Major postoperative complications occurred in 4 patients (36%). Six patients (55%) required readmission to the hospital. No operative mortalities were observed, and none of the patients required a re-operation. With a median follow-up after the procedure of 25 months (range, 6–95), none of the patients developed a pelvic recurrence. Ten patients (91%) were alive without evidence of disease and one patient (9%) developed a pancreatic recurrence. Conclusion AETV sparing the rectosigmoid and anus is feasible in highly selected patients with central pelvic recurrences. Compared to previously reported studies on total pelvic exenteration, data from this case series suggest that AETV may be associated with a lower rate of complications without compromising the oncologic outcome, while also preserving rectal function.