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Pelvic exenteration in the age of modern chemoradiation.

Abstract：

BACKGROUND:To examine outcomes after pelvic exenteration in women treated with modern chemoradiation and surgical techniques. METHODS:All patients at our institution with a diagnosis of gynecologic malignancy who underwent pelvic exenteration after treatment with chemoradiation between 1/90 and 6/08 were evaluated with a retrospective chart review. RESULTS:44 women were identified, of whom 29 (66%) had cervical, 6 (14%) had uterine, 5 (11%) had vaginal, and 4 (9%) had vulvar cancer. The majority of patients (82%) were initially treated with external beam whole-pelvic radiation with concurrent cisplatin. 38 patients (86%) underwent exenteration for a central pelvic recurrence, and the remaining 6 patients (14%) for radiation necrosis. The most common surgical complication was transfusion requirement in 36 patients (82%), followed by wound infection in 15 (34%), small bowel obstruction in 8 (18%), and sepsis in 6 (14%). The median time spent in the ICU post-operatively was 2 days. One patient (2%) died during her post-operative hospital stay. The mean EBL overall was 2497 cc and the mean operative time was 544 min. Use of electrothermal bipolar coagulation, which was used in 64% of the exenterations, significantly reduced blood loss (3679 cc vs. 1836 cc, p=0.014). After exenteration, 21 patients (48%) were diagnosed with a recurrence of cancer, and the mean progression free survival was 31 months. Patients who received exenteration less than 2 years after their initial chemoradiation had a significantly shorter overall survival time (8 months vs. 33 months, p=0.016). CONCLUSIONS:Approximately 50% of women develop recurrence following exenterations done after chemoradiation. Survival is significantly longer in patients who necessitate exenteration greater than 2 years out from initial treatment. Electrothermal bipolar coagulation appears to significantly reduce blood loss during these surgeries.

journal_name

Gynecol Oncol

journal_title

Gynecologic oncology

authors

McLean KA,Zhang W,Dunsmoor-Su RF,Shah CA,Gray HJ,Swensen RE,Goff BA

doi

10.1016/j.ygyno.2010.11.044

subject

Has Abstract

pub_date

2011-04-01 00:00:00

pages

131-4

issue

eissn

0090-8258

issn

1095-6859

pii

S0090-8258(10)00880-2

journal_volume

121

pub_type

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Pelvic exenteration in the age of modern chemoradiation.