Pelvic exenteration with curative intent for recurrent uterine malignancies

• Published in: Gynecologic oncology 2012-01, Vol.124 (1), p.42-47
• Main Authors: Khoury-Collado, Fady, Einstein, M. Heather, Bochner, Bernard H, Alektiar, Kaled M, Sonoda, Yukio, Abu-Rustum, Nadeem R, Brown, Carol L, Gardner, Ginger J, Barakat, Richard R, Chi, Dennis S
• Format: Article
• Language: English
• Subjects: Adult; Aged; Female; Hematology, Oncology and Palliative Medicine; Humans; Middle Aged; Neoplasm Recurrence, Local - pathology; Neoplasm Recurrence, Local - surgery; Obstetrics and Gynecology; Pelvic exenteration; Pelvic Exenteration - adverse effects; Pelvic Exenteration - methods; Recurrent uterine malignancies; Retrospective Studies; Survival Rate; Treatment Outcome; Uterine cancer; Uterine Neoplasms - pathology; Uterine Neoplasms - surgery
• ISSN: 0090-8258; 1095-6859
• DOI: 10.1016/j.ygyno.2011.09.031

Abstract Objective To evaluate the outcomes observed with pelvic exenteration with curative intent for recurrent uterine malignancies in the modern era. Methods We reviewed the records of all patients who underwent this procedure at our institution between 1/1997 and 03/2011. Postoperative complications up to 90 days after surgery were analyzed and graded as per our institution grading system. Survivals were estimated using the Kaplan–Meier method. Results During the study period, 21 patients were identified. Median age at the time of exenteration was 57 years (range, 36–75). Median tumor size was 6 cm (range, microscopic — 14.5). Tumor histology was: endometrioid, 10 cases; mixed, serous, and carcinosarcoma, 7 cases; and sarcomas, 4 cases. The type of exenteration was: total, 14 cases; anterior, 6 cases and posterior, 1 case. There were no intra- or postoperative mortalities. Seven patients (33%) developed at least one grade 2 complication, and 10 patients (48%) developed at least one grade 3 complication. Five (24%) patients had to be re-operated on in the first 90 days post surgery. The median follow up time after exenteration was 39 months (range, 5–112). The 5-year survival of the entire cohort was 40% (95% CI: 18–63). An improved survival was observed in patients with endometrioid tumors and sarcomas (5-year survival rates of 50% and 66%, respectively). The presence of pelvic sidewall involvement and/or hydronephrosis did not negatively affect survival. Conclusion Pelvic exenteration for recurrent uterine malignancies can be associated with long-term survival in properly selected patients. A high rate of postoperative complications remains a hallmark of this procedure and should be discussed carefully with patients facing this decision.