Ileal orthotopic neobladder after pelvic exenteration for cervical cancer

e17505 Background: The purpose of this study was to evaluate data regarding the outcome of pelvic exenteration (PE) when performed for advanced or recurring cervical cancer. Methods: A total of 24 patients underwent PE for cervical cancer at the University Hospital Marburg between 2011 and 2016. Their data were retrospectively assessed and statistically analyzed. Survival was evaluated using the Kaplan-Meyer method. Results: Mean age was 52.2 years (29.7 to 72.6 years), mean BMI was 23.4 kg/m2. Most common indication was squamous cell carcinoma, whereas 3 patients underwent PE for adenocarcinoma. The majority of the tumors (62.5%) were stage pT4. Negative margins could be achieved in 70.8%. Lymph nodes could be assessed in 55% and were tumor-afflicted in 20.8%. 45.8% were treated for recurrent cancer; median recurrence free time between previous treatment and PE was 16 months. Up-front PE was performed in 20.8%. Another 79.2% received treatment prior to PE: 20.8% received all 3 treatment modalities whereas 37.5% had two treatments before (29.2% underwent chemo- and radiotherapy, 8.3% had surgery and radiotherapy) and 20.8% underwent one type of treatment. Anterior PE (APE) and total PE (TPE) were performed in 62.5% and 37.5%, respectively. Median operation time was 324min. Blood products were administered perioperatively in 75%; 37.5% needed 2 or more. Median hospital stay was 25 days. Major complications (Clavien Dindo≥3) were observed in 41.7% and 16.7% had no complications. Overall Survival (OS) was 29.2%; median overall survival was 19.1 months. 2- and 3-year survival rates for curative PE were 50% and 35% respectively. 4 patients underwent PE with palliative intent. Overall survival correlated significantly with R1- (p = 0.012), N1- (p = 0.047) and M1-status p < 0.01), TPE (p = 0.034) and surgical time > 6 h (p = 0.003). Conclusions: In cases of advanced or recurrent cervical cancer gynecologists struggle to find suitable therapeutic options, especially since most patients have already received radio- and/or chemotherapy. PE is a valid option for selected patients that may represent a cure with tolerable complication rates.

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Survival After Curative Pelvic Exenteration for Primary or Recurrent Cervical Cancer: A Retrospective Multicentric Study of 167 Patients

International Journal of Gynecological Cancer ◽

10.1097/igc.0b013e3182a80aec ◽

2014 ◽

Vol 24 (5) ◽

pp. 916-922 ◽

Cited By ~ 28

Author(s):

Vito Chiantera ◽

Martina Rossi ◽

Pierandrea De Iaco ◽

Christardt Koehler ◽

Simone Marnitz ◽

...

Keyword(s):

Cervical Cancer ◽

Overall Survival ◽

Lymph Node ◽

Pelvic Exenteration ◽

Cell Cancer ◽

Pelvic Lymph Node ◽

Term Survival ◽

Primary Tumors ◽

Multicentric Study ◽

Recurrent Cervical Cancer

ObjectiveEvaluate the survival of patients who underwent pelvic exenteration (PE) with curative intent for primary persistent or recurrent cervical cancer.MethodsWe retrospectively investigated 167 consecutive patients, referred to the gynecological oncology units of 4 centers in Germany or Italy, who underwent PE. Data regarding surgery, histology, and oncologic outcomes were collected and statistically evaluated. Survival was determined from the day of exenteration until last follow-up or death.ResultsThe median age was 51 years. Twenty-seven patients (16.2%) underwent PE owing to advanced primary tumors (group A), 34 patients (20.4%) underwent PE owing to persistent cancer after chemotherapy or chemoradiation (group B), and 106 patients (63.4%) underwent PE owing to recurrence (group C). The prevalent histologic type was squamous cell cancer. A complete tumor resection (R0), was achieved in 121 patients (72.5%). Forty-nine patients (29.3%) had pelvic lymph node metastases and 44 patients (26.3%) had pelvic sidewall involvement. Overall survival at the end of the study was 40.7%. The cumulative 5-year overall survival for the entire cohort was 38%. Resection margins, pelvic lymph node state, and sidewall involvement were independent prognostic factors in multivariate analysis.ConclusionPelvic exenteration is a valid therapeutic option for patients with locally advanced primary persistent or recurrent cervical cancer, with a long-term survival in 40% of the patients.

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Total Pelvic Exenteration/Radical Hysterectomy for Cervical Cancer

Surgical Pathology Dissection ◽

10.1007/978-1-4612-2398-6_15 ◽

1996 ◽

pp. 29-30

Author(s):

Ralph H. Hruban ◽

William H. Westra ◽

Timothy H. Phelps ◽

Christina Isacson

Keyword(s):

Cervical Cancer ◽

Radical Hysterectomy ◽

Pelvic Exenteration ◽

Total Pelvic Exenteration

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Pelvic exenteration for cervical cancer: An endangered skill?

Gynecologic Oncology ◽

10.1016/j.ygyno.2018.04.182 ◽

2018 ◽

Vol 149 ◽

pp. 80

Author(s):

K. Miller ◽

S.E. Dilley ◽

M.I. Liang ◽

S. Bae ◽

W. Huh

Keyword(s):

Cervical Cancer ◽

Pelvic Exenteration

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Curative anterior pelvic exenteration for pelvic recurrence after irradiated, surgically treated cervical cancer. A case report and literature review

Gineco eu ◽

10.18643/gieu.2016.161 ◽

2016 ◽

Vol 12 (4) ◽

pp. 161-165

Author(s):

Bacalbasa N.

Keyword(s):

Cervical Cancer ◽

Case Report ◽

Literature Review ◽

Pelvic Exenteration ◽

Pelvic Recurrence

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Surgical primary treatment of stage IVA cervical cancer: A multicenter retrospective study.

Journal of Clinical Oncology ◽

10.1200/jco.2012.30.15_suppl.e15551 ◽

2012 ◽

Vol 30 (15_suppl) ◽

pp. e15551-e15551

Author(s):

Patrizio Damiani ◽

Francesco Plotti ◽

Marzio Angelo Zullo ◽

Carlo De Cicco Nardone ◽

Roberto Montera ◽

...

Keyword(s):

Cervical Cancer ◽

Retrospective Study ◽

Pelvic Exenteration ◽

Frozen Section ◽

Colorectal Anastomosis ◽

Disease Free Survival ◽

Primary Treatment ◽

Total Pelvic Exenteration ◽

Systematic Lymphadenectomy ◽

Paraaortic Lymph Nodes

e15551 Background: The aim of the present study is to describe feasibility, surgical technique, perioperative data, early and late complications of anterior and total pelvic exenteration after neoadjuvant chemotherapy as primary treatment for stage IVa cervical cancer. Methods: It is a retrospective study which included 73 consecutive patients affected by stage IVa cervical cancer who required anterior or total pelvic exenteration referred to 3 international gynaecologic oncology centres. The steps of this extirpative surgical procedure were: 1) staging laparotomy; 2) frozen section biopsy of the paraaortic lymph nodes; 3) systematic lymphadenectomy, radical hysterectomy with adnexectomy and total or anterior pelvic exenteration; 4) continent urinary diversions and low colorectal anastomosis if it was possible. Results: The treatment of patients affected by FIGO stage IVA cervical cancer remains one of the most complex procedures gynecologic oncologists are faced with. Our study focused on clinical and operative data , in terms of overall survival (OS) and disease free survival (DFS) at 5 years. 5-year OS of our series was 43%. Conclusions: The surgical treatment of stage IVA cervical cancer appears therefore a suitable and valid alternative. Stage IVA cervical cancer patients in good general condition, with a disease resectable with clear surgical margins, should be considered for primary exenteration in referral centers where the surgical experience to perform this procedure is available.

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