Introduction: Indication of primary pelvic exenteration, without previous radiotherapy, is questionable in advanced stages of gynaecological malignancies.
Materials and Methods: 24 patients who underwent primary pelvic exenteration for pelvic malignancies were studied retrospectively. The indications were cervical (n=17), vaginal (n=4), bladder (n=2) and endometrial cancer (n=1).
Results: According to the type of exenteration, 14 were anterior and 10 total. Relying on the resection lines in relation with levator ani muscles, 14 were supralevatorial and 10 infralevatorial, of which five involved vulvectomy. Early complications occurred in 7 patients with 1 perioperative death.
Conclusions: Primary pelvic exenterantion as first line therapy for advanced gynaecological malignancies can lead to long-term survival and it can even be curative in suitable selected patients. Still, postoperative complications are frequent, which can be lethal.
If the inline PDF is not rendering correctly, you can download the PDF file here.
1. Căpîlna ME, Moldovan B, Becsi J, et al. Exenteraţia pelvină – tehnici chirurgicale. 1st ed. București: Editura Didactică și Pedagogică; 2016.
2. Marnitz S, Köhler C, Müller M, et al. Indications for primary and secondary exenterations in patients with cervical cancer. Gynecologic Oncology. 2006;103:1023-1030.
3. Laszlo Ungar L, Laszlo Palfalvi, Zoltan Novak. Primary pelvic exenteration in cervical cancer patients. Gynecologic Oncology. 2008;111:S9-S12.
4. Pathiraja P, Sandhu H, Instone M, et al. Should pelvic exenteration for symptomatic relief in gynaecology malignancies be offered?.Archives of Gynecology and Obstetrics. 2014;289:657-662.
5. Dindo D, Demartines N, Clavien PA. Classification of surgical complications. A new proposal with evaluation in a cohort of 6336 patients and results of a survey. Annals of Surgery. 2004;240(2):205-213.
6. Höckel M, Dornhofer N. Review. Pelvic exenteration for gynaecological tumours: achievements and unanswered questions. Lancet Oncol. 2006;7:837-847.
7. Friedlander M, Grogan M. Guidelines for the treatment of recurrent and metastatic cervical cancer. Oncologist. 2002;7:342-347.
8. Jager L, Nilsson PJ, Floter Radestad A. Pelvic Exenteration for Recurrent Gynecologic Malignancy. A Study of 28 Consecutive Patients at a Single Institution. Int J Gynecol Cancer. 2013;23:755-762.
9. Diver EJ, Rauh-Hain JA, del Carmen MG. Total Pelvic Exenteration for Gynecologic Malignancies. International Journal of Surgical Oncology. 2012;1-9.
10. Berek JS, Howe C, Lagasse LD, et al. Pelvic exenteration for recurrent gynecologic malignancy: survival and morbidity analysis of the 45-year experience at UCLA. Gynecologic Oncology. 2005;99(1):153-159.
11. Boggess JF, Gehrig PA, Cantrell L, Shafer A, Ridgway M, Skinner EN, et al. A comparative study of 3 surgical methods for hysterectomy with staging for endometrial cancer: robotic assistance, laparoscopy, laparotomy. Am J Obstet Gynecol. 2008;199(4):360.e1-360.e9.
12. Veljovich DS, Paley PJ, Drescher CW, Everett EN, Shah C, Peters WA. Robotic surgery in gynecologic oncology: program initiation and outcomes after the first year with comparison with laparotomy for endometrial cancer staging. Am J Obstet Gynecol. 2008;198(6):679.e1-679.e10.