Pelvic exenteration: Ten-year experience at the European Institute of Oncology in Milan

• Published in: Gynecologic oncology Vol. 114; no. 1; pp. 64 - 68
• Main Authors: Maggioni, Angelo, Roviglione, Giovanni, Landoni, Fabio, Zanagnolo, Vanna, Peiretti, Michele, Colombo, Nicoletta, Bocciolone, Luca, Biffi, Roberto, Minig, Lucas, Morrow, C. Paul
• Format: Journal Article
• Language: English
• Published: United States Elsevier Inc 01.07.2009
• Subjects: Adult; Aged; Cervical cancer; Combined Modality Therapy; Endometrial Neoplasms - radiotherapy; Endometrial Neoplasms - surgery; Female; Gynecologic malignancies; Gynecologic surgery; Hematology, Oncology and Palliative Medicine; Humans; Italy; Middle Aged; Obstetrics and Gynecology; Ovarian Neoplasms - radiotherapy; Ovarian Neoplasms - surgery; Pelvic exenteration; Pelvic Exenteration - adverse effects; Pelvic Exenteration - methods; Radical surgery; Retrospective Studies; Survival Rate; Survivors; Uterine Cervical Neoplasms - radiotherapy; Uterine Cervical Neoplasms - surgery; Vaginal Neoplasms - radiotherapy; Vaginal Neoplasms - surgery; Vulvar Neoplasms - radiotherapy; Vulvar Neoplasms - surgery; Italy; Pelvic exenteration; Gynecologic surgery; Cervical cancer; Gynecologic malignancies; Radical surgery
• ISSN: 0090-8258; 1095-6859
• DOI: 10.1016/j.ygyno.2009.03.029

Abstract Objectives Analyze morbidity and survival after pelvic exenteration (PE) of gynecological malignancies. Methods We reviewed 106 consecutive patients with gynecologic malignancies who underwent PE from June 1996 to April 2007 at the Division of Gynecology, European Institute of Oncology (IEO), Milan. Results PE was performed for cancer of the cervix (62 patients), vagina (21 patients), vulva (9 patients), endometrium (9 patients), ovary (4 patients) and 1 uterine sarcoma. Mean age was 53.6 (30–78) years. 97% of the patients received radiotherapy before PE and 3 patients had PE as primary treatment. We performed 53 anterior, 48 total and 5 posterior PE. Median operation time, estimated blood loss and hospital stay were respectively 490 (200–780) minutes, 1240 (300–6500) ml and 21.6 (11–55) days. No residual tumor was left in 93% of the patients. Median follow-up was 22.3 (1.6–117) months. There were no post-operative deaths (< 30 days from surgery) nor intra-operative mortality. Total morbidity rate was 66%; 48% of patients had early complications (< 30 days after PE) whereas 52 patients (48.5%) had late complications; 70% of these occurred to the urinary tract and 25% were due to bowel occlusions or fistulas. Overall survival was 52%, 35%, 19% and 16% respectively for cervical, endometrial, vaginal and vulvar cancer. Conclusions PE is a feasible technique with no post-operative mortality and high percentage of long-survivors, although the morbidity rate still remains significantly high. Careful patient selection, pre- and post-operative care and optimal surgical skills in a Gynecologic Oncologic Center are the cornerstones to further improve quality of life and survival for these patients.