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Original Research

Open Access

Is long-term survival possible when conventional cervical cancer treatment options are exhausted?

  • Olav Tammik1,2,*,
  • Aavo Lang3
  • Heti Pisarev3
  • Katrin Lang3
  • Karin Tammik4

1Department of General and Cancer Surgery, Surgery Clinic, North Estonian Medical Centre, 13419 Tallinn, Estonia

2Department of Surgical Oncology and Gynecology, Clinicum of University of Tartu, 50406 Tartu, Estonia

3Institute of Biomedicine and Translational Medicine, University of Tartu, 50406 Tartu, Estonia

4Tartu Health Care College, 50411 Tartu, Estonia

DOI: 10.22514/ejgo.2024.027 Vol.45,Issue 2,April 2024 pp.52-59

Submitted: 03 October 2023 Accepted: 26 October 2023

Published: 15 April 2024

*Corresponding Author(s): Olav Tammik E-mail: olav.tammik@kliinikum.ee

Abstract

When local recurrence happens, treatment options are limited due to the frequent use of pelvic irradiation for primary cervical cancer. Reirradiation is usually contraindicated and chemotherapy is ineffective at controlling tumors located within the previously irradiated tissue, in the case of persistent or recurrent cervical cancer, pelvic exenteration (PE) is on of the few options to offer patients a radical treatment. This is the first analysis from Estonia evaluating prognostic factors associated with locally advanced cervical cancer and the potential for long-term survival with pelvic exenteration. Between 2001 and 2021, PE was performed in 25 patients with recurrent or persistent pelvic cancer after radical radiochemotherapy. Included were 22 cervical cancer and 3 vaginal cancer cases who were followed until 01 June 2022. Clinicopathological characteristics of patients were described in univariate analysis and prognostic factors were estimated with Cox proportional hazard analysis. The median age was 58 years (range 34–80). Median tumor diameter was 6 cm (range 2–14 cm). Total PE, anterior PE and PE with rectal anastomosis consisted of 44%, 36% and 20% of cases respectively. Additional vulvectomy was performed 28% of patients. The median follow-up was 92 months. The overall postoperative complication rate was 32%; the postoperative mortality rate was 0%. Median hospitalization was 16 days (range 9–34). Overall survival was as follows: 1 year 64%, 3 year 40%, 5 year 32% and 15 year 24%. In this case series, we find that even in patients with recurrent or persistent locally advanced cervical cancer, at least a quarter of patients treated with pelvic exenteration can achieve a survival of more than 15 years. PE can be performed with a low postoperative complication rate and zero mortality. PE allows significantly longer survival for patients who have exhausted other treatment modalities.


Keywords

Cervical cancer; Pelvic exenteration; Complications; Long-term survival


Cite and Share

Olav Tammik,Aavo Lang,Heti Pisarev,Katrin Lang,Karin Tammik. Is long-term survival possible when conventional cervical cancer treatment options are exhausted?. European Journal of Gynaecological Oncology. 2024. 45(2);52-59.

References

[1] Egger EK, Liesenfeld H, Stope MB, Recker F, Döser A, Könsgen D, et al. Pelvic exenteration in advanced gynecologic malignancies—who will benefit? Anticancer Research. 2021; 41: 3037–3043.

[2] Sevin B, Koechli OR. Pelvic exenteration. Surgical Clinics of North America. 2001; 81: 771–779.

[3] Zoucas E, Frederiksen S, Lydrup M, Månsson W, Gustafson P, Alberius P. Pelvic exenteration for advanced and recurrent malignancy. World Journal of Surgery. 2010; 34: 2177–2184.

[4] Chokshi RJ, Fowler J, Cohn D, Bahnson R, Lumbley J, Martin E Jr. A single-institution approach to total pelvic exenteration. The American Surgeon. 2011; 77: 1629–1639.

[5] Brunschwig A. Complete excision of pelvic viscera for advanced carcinoma. A one-stage abdominoperineal operation with end colostomy and bilateral ureteral implantation into the colon above the colostomy. Cancer. 1948; 1: 177–183.

[6] Zhang Z, Zang R and Chen J. Pelvic exenteration of advanced gynecological malignacies: a report of 18 cases. Chinese Journal of Obstetrics and Gynecology. 2000; 35: 288–290. (In Chinese)

[7] Rios-Doria E, Filippova OT, Straubhar AM, Chi A, Awowole I, Sandhu J, et al. A modern-day experience with Brunschwig’s operation: outcomes associated with pelvic exenteration. Gynecologic Oncology. 2022; 167: 277–282.

[8] Goldberg JM, Steven Piver M, Hempling RE, Aiduk C, Blumenson L, Recio FO. Improvements in pelvic exenteration: factors responsible for reducing morbidity and mortality. Annals of Surgical Oncology. 1998; 5: 399–406.

[9] Fong Y, Gonen M, Rubin D, Radzyner M, Brennan MF. Long-term survival is superior after resection for cancer in high-volume centers. Annals of Surgery. 2005; 242: 540–547.

[10] Pelv Ex Collaborative. Palliative pelvic exenteration: a systematic review of patient-centered outcomes. European Journal of Surgical Oncology. 2019; 45: 1787–1795.

[11] Gheorghe M, Cozlea AL, Kiss SL, Stanca M, Caplina ME, Bacalbasa N, et al. Primary pelvic exenteration: our experience with 23 patients from a single institution. Experimental and Therapeutic Medicine. 2021; 22: 1060.

[12] ter Glane L, Hegele A, Wagner U, Boekhoff J. Pelvic exenteration for recurrent or advanced gynecologic malignancies—analysis of outcome and complications. Gynecologic Oncology Reports. 2021; 36: 100757.

[13] Martinez-Gomez C, Angeles MA, Martinez A, Malavaud B, Ferron G. Urinary diversion after pelvic exenteration for gynecologic malignances. International Journal of Gynecological Cancer. 2021; 31: 1–10.

[14] Lewandowska A, Szubert S, Koper K, Koper A, Cwynar G, Wicherek L. Analysis of long-term outcomes in 44 patients following pelvic exenteration due to cervical cancer. World Journal of Surgical Oncology. 2020; 18: 234.

[15] Stanca M, Căpîlna DM, Căpîlna ME. Long-term survival, prognostic factors, and quality of life of patients undergoing pelvic exenteration for cervical cancer. Cancers. 2022; 14: 234.

[16] Pleth Nielsen CK, Sørensen MM, Christensen HK, Funder JA. Complications and survival after total pelvic exenteration. European Journal of Surgical Oncology. 2022; 48: 1362–1367.

[17] Dessai SB, Balasubramanian S, Patil VM, Chakraborty S, Bhattacharjee A, Vikram S. Pelvic exenteration: experience from a rural cancer center in developing world. International Journal of Surgical Oncology. 2015; 2015: 729658.

[18] Domes T. Total pelvic exenteration for rectal cancer: outcomes and prognostic factors. Canadian Journal of Surgery. 2011; 54: 387–393.

[19] Kecmanovic DM, Pavlov MJ, Kovacevic PA, Sepetkovski AV, Ceranic MS, Stamenkovic AB. Management of advanced pelvic cancer by exenteration. European Journal of Surgical Oncology. 2003; 29: 743–746.

[20] Vigneswaran HT, Schwarzman LS, Madueke IC, David SM, Nordenstam J, Moreira D, et al. Morbidity and mortality of total pelvic exenteration for malignancy in the US. Annals of Surgical Oncology. 2021; 28: 2790–2800.

[21] Marnitz S, Köhler C, Müller M, Behrens K, Hasenbein K, Schneider A. Indications for primary and secondary exenterations in patients with cervical cancer. Gynecologic Oncology. 2006; 103: 1023–1030.

[22] Chiantera V, Rossi M, De Iaco P, Koehler C, Marnitz S, Ferrandina G, et al. Survival after curative pelvic exenteration for primary or recurrent cervical cancer: a retrospective multicentric study of 167 patients. International Journal of Gynecologic Cancer. 2014; 24: 916–922.

[23] Zimmermann ML, Mägi M, Härmaorg P, Innos K. Cancer incidence in Estonia 2018. National Institute for Health Development: Tallinn. 2021.

[24] Bouraoui I, Bouaziz H, Tounsi N, Ben Romdhane R, Hechiche M, Slimane M, et al. Survival after pelvic exenteration for cervical cancer. The Journal of Obstetrics and Gynecology of India. 2022; 72: 66–71.o[25] Petruzziello A, Kondo W, Hatschback SB, Guerreiro JA, Filho F, Vendrame C, et al. Surgical results of pelvic exenteration in the treatment of gynecologic cancer. World Journal of Surgical Oncology. 2014; 12: 279.

[26] de Gregorio N, de Gregorio A, Ebner F, Friedl TWP, Huober J, Hefty R, et al. Pelvic exenteration as ultimate ratio for gynecologic cancers: single-center analyses of 37 cases. Archives of Gynecology and Obstetrics. 2019; 300: 161–168.

[27] Baiocchi G, Guimaraes GC, Rosa Oliveira RA, Kumagai LY, Faloppa CC, Aguiar S, et al. Prognostic factors in pelvic exenteration for gynecological malignancies. European Journal of Surgical Oncology. 2012; 38: 948–954.

[28] Chao X, Song X, Wu H, You Y, Wu M, Li L. Selection on treatment regimens for recurrent cervical cancer. Frontiers in Oncology. 2021; 11: 618485.

[29] Peiretti M, Zapardiel I, Zanagnolo V, Landoni F, Morrow CP, Maggioni A. Management of recurrent cervical cancer: a review of the literature. Surgical Oncology. 2012; 21: e59–e66.

[30] Ter Glane L, Hegele A, Wagner U, Boekhoff J. Gynocologic oncology: pelvic exenteration for advanced or recurring cervical cancer—a single center analysis. Cancer Diagnosos & Prognosis. 2022; 2: 308–315.

[31] Mailankody S, Dhanushkodi M, Ganesan TS, Radhakrishnan V, Christopher V, Ganesharjah S. Recurrent cervical cancer treated with palliative chemotherapy: real-world outcome. ecancer. 2020; 14: 1122.

[32] Li L, Ma S, Tan X, Zhong S, Wu M. Pelvic exenteration for recurrent and persistent cervical cancer. Chinese Medical Journal. 2018; 131: 1541–1548.


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