Pelvic exenteration in advanced and recurrent cervical cancer

ABSTRACT

Pelvic exenteration consists in a radical surgical procedure for patients with advanced and recurrent cervical cancer and it offers the chance for cure. Surgical techniques have been developed for reducing morbidity and mortality. From July 2005 to September 2009, Pelvic Exenteration was performed for 20 patients with primary advanced cancer cervix and 10 patients with recurrent cervical carcinoma. Full data about the surgery [type of exenteration, type of feacal and urinary diversion, lymph node dissection, and operative morbidity] was recorded. No operation-related mortality, the complications rate was 23.3% and the overall mean survival was 34.7 months [95% CI=28.0-41.5]. Multiple factors were analyzed [univariate analysis] to determine their association with long-term survival. Mean survival was 37.2 months [95% CI 29.7-44.7] in the primary group and was 21.6 months [95% CI=12.8-30.4] in the recurrent group [p=0.033 by Cox regression]. An important prognostic factor was the margin status. Mean survival was 39.2 months [95% CI<=33.0-45.4] for patients with tumor-free resection margins and was 6.4 months [95% CI=3.3-9.5] for those with positive margins [p<0.001 by Cox regression]. In patients with primary advanced cervical cancer, exenteration is a valid alternative to primary chemoradiation. In patients with recurrent tumor limited to the pelvis, secondary exenteration should be offered without post operative mortality although the morbidity rate is still high. Univariate analysis showed that margin status is important prognostic factor for survival