Document Detail


Pelvic Exenterations for Gynecological Malignancies: A Study of 36 Cases.
MedLine Citation:
PMID:  22617477     Owner:  NLM     Status:  Publisher    
Abstract/OtherAbstract:
OBJECTIVE: Evaluation of surgical outcomes, survival, and morbidity associated with pelvic exenteration (PE) performed for gynecologic malignancies. METHODS: Review of 36 consecutive patients who underwent PE between June 1999 and April 2010. RESULTS: Pelvic exenteration was performed for cancer of the cervix (n = 18), endometrium (n = 9), vagina/vulva (n = 8), and ovary (n = 1). Four patients underwent PE as primary treatment and 32 patients for recurrent disease after pelvic radiotherapy. Median age was 57 years (range, 35-81 years). Bricker (n = 17), Mainz pouch (n = 10), and augmentation after bladder resection (n = 6) were used as urinary derivations. J-pouch coloanal anastomosis was performed in 14, colostomy in 13, and side-to-end anastomosis in 4 patients. There was no operative mortality. The most important postoperative complications were rectovaginal fistula (5), urinary leakage (2), vesicovaginal fistula (1), and sepsis (3). One of the 6 patients with a partial cystectomy developed a vesicovaginal fistula, which was successfully treated with a Martius flap. With a median follow-up of 78 months (range, 2-131) months, the 5-year overall and disease-specific survival (DSS) rates were 44% and 52%, respectively. Five-year DSS for cervical, endometrial, and vaginal/vulvar cancer was 44%, 80%, and 57%, respectively. Combined operative and radiotherapeutic treatment (CORT) was performed in 3 patients with pelvic side wall relapse. Of the 15 patients 65 years or older, a 5-year DSS of 71% was observed in comparison with 42% in the younger subgroup, and their complication rates were similar to the younger patient group. Thirteen patients (36%) reported to have psychological disturbances associated with stoma-related problems. Only 3 patients requested a vaginal reconstruction during follow-up. CONCLUSIONS: Pelvic exenteration offers a sustained survival with an acceptable morbidity in patients with advanced or recurrent gynecologic cancer. Older age was not associated with higher morbidity/mortality in this series.
Authors:
Manpreet Kaur; Steven Joniau; André D'Hoore; Ben Van Calster; Erik Van Limbergen; Karin Leunen; Freddy Penninckx; Hendrik Van Poppel; Frederic Amant; Ignace Vergote
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Publication Detail:
Type:  JOURNAL ARTICLE     Date:  2012-5-20
Journal Detail:
Title:  International journal of gynecological cancer : official journal of the International Gynecological Cancer Society     Volume:  -     ISSN:  1525-1438     ISO Abbreviation:  -     Publication Date:  2012 May 
Date Detail:
Created Date:  2012-5-23     Completed Date:  -     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  9111626     Medline TA:  Int J Gynecol Cancer     Country:  -    
Other Details:
Languages:  ENG     Pagination:  -     Citation Subset:  -    
Affiliation:
*Division of Gynaecological Oncology, Department of Obstetrics and Gynaecology, and Leuven Cancer Institute, University Hospitals of Leuven; Departments of †Urology, ‡Abdominal Surgery, and §Obstetrics and Gynecology and Leuven Cancer Institute, University Hospitals, KU Leuven; and ∥Department of Radiotherapy-Oncology, University Hospitals of Leuven, Belgium.
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