Pelvic Exenteration for Cervical Cancer: Oncological, Morbidity and Quality of Life Outcomes.

Abstract

Background and objectives: One third of patients who undergo definitive chemoradiotherapy for locally advanced cervical cancer develop disease recurrence. Salvage surgery in the form of pelvic exenteration (PE) may offer improved survival and possibly cure in carefully selected patients, however robust data is scarce. This study aimed to describe margin status, morbidity, survival and quality of life (QOL) outcomes following PE for cervical cancer at a high-volume center. Primary outcome was histological margin clearance; secondary outcomes were postoperative complications, overall survival (OS) and QOL.

Methods: Retrospective review of prospectively collected data for all adult patients undergoing PE for cervical cancer at Royal Prince Alfred Hospital, Sydney, between 1994 and 2024. Physical and mental QOL were measured quantitatively at 6-monthly intervals using the SF-36, FACT-G and FACT-C scores.

Results: A total of 24 exenterations were performed for persistent or recurrent cervical cancer, median age 44 years, 87.5% curative intent. Total PE performed in 58.3%; bone resection in 29.2%; common and/or external iliac vascular resection in 20.8%; major nerve resection in 33.3%. Clavien-Dindo III-IV complications occurred in 37.5%, including unplanned return to theatre in 25.0%. R0 resection was achieved in 81% of curative intent PE. Median OS was 45.6 months; 1-year, 3-year and 5-year OS 74%, 62% and 48%, respectively. Survival after palliative PE ranged from 5.6 to 9.0 months. Improved QOL was demonstrated at 6 months and sustained until 30 months post-operatively.

Conclusion: PE for carefully selected patients with cervical cancer can offer encouraging R0 resection rates, acceptable QOL, and the potential for long-term survival. Morbidity and oncological outcomes are comparable to international data.