The role of pelvic exenteration for treatment of pelvic malignancy - a nine-year experience

Pelvic exenteration offers the last chance for some women with gynecological and rectal malignancy. A series of 23 patients who underwent pelvic exenteration for local advanced gynecological and rectal malignancies between 1996 and 2004 were retrospectively reviewed. The exenteration was performed because of vulvar cancer in 14 patients and other pelvic malignancies in nine cases: rectal cancer in four cases, in three cases cervical cancer, in one case ovarian cancer and in one case uterine sarcoma. Nine patients developed major complications of the operative field involving the urinary tract or the wound. Early complications included massive bleeding from the sacral plexus in two cases (one patient died during surgery), acute respiratory distress syndrome (ARDS) in one case and thrombophlebitis in one case. Urinary incontinence was observed in two women as a late complication. Only one patient had a complication connected with the gastrointestinal tract. Twenty-two patients were followed-up. In the group of patients with vulvar cancer five women died after 4-29 months because of recurrence of disease. The nine surviving patients are still being followed-up and are without disease; survival time ranges from 6-74 months. In the group of patients with other malignancies four women died.

Complications; Pelvic exenteration; Gynaecological cancer; Rectal cancer; Vulvar cancer

[1] Numa F., Ogata H., Suminami Y. et al.: "Pelvic exenteration for the treatment of gynecological malignancies". Arch. Gynecol Obstet., 1997, 259, 133.

[2] Franchi M., Donadello N.: "Pelvic exenteration in gynecological oncology. Review". Eur. J. Gynecol. Oneal., 1994, 15, 469.

[3] Rutledge F.N., Smith J.P., Wharton J.T., O'Quinn A.G.: "Pelvic exenteration: analysis of 296 patients". Am. J. Obstet. Gynecol., 1977, 129, 881.

[4] Wheeless C.R. Jr.: "Recent advances in surgical reconstruction of the gynecologic cancer patient". Curr. Opin. Obstet. Gynecol., 1992, 4, 91.

[5] Chang H.K., Lo K., Chiang H.S.: "Complication of urinary diversion after pelvic exenteration for gynecological malignancy". Int. Urogynecol. J., 2000, 11, 368.

[6] Bramhall S.R., Harrison J.D., Burton A. et al.: "Phase II trail of radical surgery for locally advanced pelvic neoplasia". Br. J. Surg., 1999, 86, 805.

[7] Saunders N.: "Pelvic exenteration: by whom and for whom?" Lancet, 1995, 345, 5.

[8] Crowe P.J., Temple W.J., Lopez M.J., Ketcham A.S.: "Pelvic exenteration for advanced pelvic malignancy". Semin. Surg. Oncol., 1999, 17, 152.

[9] Hector R.C., Alfonso T., Mario D.L.G. et al.: "Pelvic exenteration for carcinoma of the cervix: analysis of 252 cases". J. Surg. Oneal., 1988, 38, 121.

[10] Thorntorn W.N., Flanagan W.C.: "Pelvic exenteration in the treatment of the advanced malignancy of vulva". Am. J. Obstet. Gynecol., 1973, 117, 774.

[11] Kiselow M., Butcher H.R. Jr., Bricker E.M.: "Results of the radical surgical treatment of advanced pelvic cancer: a fifteen-year study". Ann. Surg., 1967, 166, 428.

[12] Shingleton H.M., Soong S.J., Gelder M.S., Hatch K.D., Baker V.V., Austin J.M. Jr.: "Clinical and histopathologic factors predieting recurrence and survival at,ter pelvic exenteration for cancer of the cervix". Obstet. Gynecol., 1989, 73, 1027.

[13] Bladou F., Houvenaeghel G., Delpero J.R. et al.: "Incidence and management of major urinary complications after pelvic exenteration for gynaecological malignancies". J. Surg. Oneal., 1995, 58, 91.

[14] Lopez M.J., Luna-Perez P.: "Composite pelvic exenteration: is it worthwhile?". Ann. Surg. Oncol., 2004, 11, 27.

[15] Averette H.E., Lichtinger M., Sevin B.U. et al.: "Pelvic exenteration: a 15 year experience in a general metropolitan hospital". Am J. Obstet. Gynecol., 1984, 150, 179.

[16] J Ehrlich R.M.: "An improved method of creating an ileal conduit: the importance of a better vascular supply". J. Urol., 1973, 109, 993.

[17] Hatano T., Hayakawa M., Koyama Y., Sugaya K., Miyazato T., Ogawa Y.: "An alternative procedure for the creation of an ileal conduit in patients undergoing pelvic exenteration: dextrotransmesenteric location". World J. Urol., 1998, 16, 410.

[18] Penalver M. A., Bejany D.C., Averette H.E. et al.: "Continent urinary diversion in gynaecological oncology". Gynecol. Oneal., 1989, 34, 274.

[19] Shepherd J.H., Ngan H.Y.S., Neven P. et al.: "Multivariate analysis of factor affecting survival in pelvic exenteration". Int. J Gynecol. Cancer, 1994, 4, 361.

[20] Morley G.W.: "Pelvic exenteration, University of Michigan: 100 patients at 5 years". Obstet. Gynecol., 1989, 74, 934.