Cancer Science & Therapy

Pelvic Exenteration for Centrally Recurrent Gynaecological Malignancy

Abstract

Sebastian Smolarek, Rami Radwan, Martyn Evans, Pradeep Bose, Peter Drew, John Beynon and Kerryn Lutchman-Singh

Background: Pelvic exenteration is an extensive operation, which offers the potential of cure to women with centrally recurrent gynaecological malignancy. The aim of this study was to assess the clinical outcome and factors influencing survival in these patients.

Methods: This was an observational cohort study of all patients who underwent pelvic exenteration for centrally recurrent gynaecological malignancy between March 1999 and October 2015. Data were collected from both the pelvic and gynaecologic oncology prospective databases. Determinants of survival were analysed using Kaplan-Meier survival curves.

Results: This study included 41 women who underwent pelvic exenteration for centrally recurrent gynaecological malignancy. The median patient age was 66 (range 27-79) years with a median follow up of 30 (range 0.4- 178) months. The median survival time was 22.3 (range 0-178.4) months. The 5- year survival rate was 32.4% for the entire cohort. A negative resection margin (R₀) was achieved in 85.4% (35/41). This group had a median survival of 36.2 (range 0.4-178.4) months compared to patients who had a positive resection margin (R₁), who had a median survival of 9.8 (range 1.2-15.1) months (p=0.0053). Postoperative radiotherapy was administered in 24.4% (10/41). Postoperative morbidity and mortality rates were 51% and 2.4% respectively. Major complications were noted in 24.4% of patients.

Conclusion: Pelvic exenteration for recurrent gynaecological malignancy was associated with a reasonably good survival rate, especially if complete resection was achieved. Optimising patient selection and peri-operative care, combined with a high-quality multi-disciplinary surgical approach are key factors in achieving good outcomes.