Analysis of long-term outcomes in 44 patients following pelvic exenteration due to cervical cancer
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(2020) 18:234
RESEARCH
Open Access
Analysis of long-term outcomes in 44 patients following pelvic exenteration due to cervical cancer Agnieszka Lewandowska1, Sebastian Szubert1,2, Krzysztof Koper3, Agnieszka Koper3, Grzegorz Cwynar1 and Lukasz Wicherek1*
Abstract Background: Pelvic exenteration (PE) may be associated with prolonged overall survival (OS) in selected patients with advanced or recurrent cervical cancer. However, the factors related to improved survival following PE are not clearly defined. The aim of this study was to perform a retrospective analysis of OS rates in a group of patients undergoing PE in order to identify the factors related to improved long-term outcomes. Methods: Our study group consisted of 44 patients, including 21 squamous cell cancer (SCC) patients, 22 patients with adenocarcinomas (AC) of the cervix, and one patient with undifferentiated cervical carcinoma. The patients were categorized according to the type of surgery, namely, primary surgery (12 patients) or surgery due to cancer recurrence (32 patients). Results: In the group of patients with recurrent cervical cancer, we found that improved OS correlated with the SCC histological type and the presence of vaginal fistula. The need for reoperation within 30 days and the presence of severe adverse events significantly worsened the prognosis. We found a non significant trend toward improved survival in those patients with tumor-free margins. Lymph node metastases, the initial stage of the disease, the time to recurrence, and a history of hysterectomy had no impact on patients’ OS. In the group of patients undergoing primary PE, we observed a trend toward improved survival among those diagnosed with vaginal fistula. Conclusions: Pelvic exenteration seemed to improve the long-term outcomes for patients with SCC cancer recurrence and vaginal fistula whose surgery was unrelated to severe adverse events. Keywords: Pelvic exenteration, Cervical cancer, Cancer recurrence, Vaginal fistula
Introduction Pelvic exenteration was first described by Brunschwig in 1948 as a palliative procedure for patients with advanced pelvic malignancies [1]. Since then pelvic exenteration has become a routine surgical procedure—an option of choice for treating the relapse of pelvic malignancy due to either palliative or therapeutic indications for surgery—and has resulted * Correspondence: [email protected] 1 2nd Department of Obstetrics and Gynecology, Centre of Postgraduate Medical Education, Bielanski Hospital, Ceglowska 80 St, 01-809 Warsaw, Poland Full list of author information is available at the end of the article
in long-term outcome benefits for patients. However, despite improvements in surgical techniques and better postoperative management over the last two decades, such an extensive and complex surgical procedure is still associated with a high rate of postoperative complications. Nevertheless, the survival benefit of the procedure has been well documented, particularly in cases of cervical cancer relapse where negative resection (R0
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