Pelvic exenteration in modern gynecologic oncology – own experiences

Abstract

Aim: Analysis of indications for the procedure of exenteration, and intra- and postoperative complications, based on cases from a single gynecologic oncology center over the past 5 years. Material and methods: Detailed review of medical records of female patients who underwent pelvic exenteration surgery over the last 5 years (2014–2018). The review excluded cases of exenteration for ovarian cancer. The analysis included indications for the procedure, age of operated patients, location and histological type of tumor, prior treatment history, performance status and comorbidities, purpose and type of procedure, duration of operation, early and late complications according to the Clavien–Dindo classification, method of urinary diversion, and achieved surgical margins. Results: A total of 8 pelvic exenteration procedures were performed between early 2014 and mid-2018, including 5 procedures with the intention to cure, and 3 palliative procedures. Half of the cases involved patients with recurrence of vulvar cancer. The mean duration of the procedure was 315 minutes, while the mean duration of stay in the hospital ward was 24.38 days. Early postoperative complications of varying severity occurred in each operated case, with severe complications (grades IIIb–V based on the Clavien-Dindo classification) observed in 5 women (62.5%). Abstract for pelvic exenteration in gynecologic oncology is the recurrence of cervical cancer or persistent cervical cancer after chemoradiotherapy, advanced vulvar cancer, lack of response to chemoradiotherapy, and recurrence of vulvar or vaginal cancer. Pelvic exenteration can also be a part of surgical treatment for advanced ovarian cancer (7) . The main aim of the study is the analysis of indications for performing exenteration, and intra- and postoperative complications of the procedure, based on cases of exenteration performed in our medical facility over the past 5 years. There were no deaths in the early postoperative period. Late complications were observed in a total of 6 women (75.0%), including one death 11 months after palliative exenteration. Conclusions: Despite advances in perioperative care, pelvic exenteration is associated with a high risk of complications which are often life-threatening. The eligibility of patients for this radical surgical approach should be assessed on a case-by-case basis, and the procedure itself should be carried out in a medical center with properly trained staff and medical equipment.