TY - JOUR
T1 - Pelvic exenteration
T2 - Ten-year experience at the European Institute of Oncology in Milan
AU - Maggioni, Angelo
AU - Roviglione, Giovanni
AU - Landoni, Fabio
AU - Zanagnolo, Vanna
AU - Peiretti, Michele
AU - Colombo, Nicoletta
AU - Bocciolone, Luca
AU - Biffi, Roberto
AU - Minig, Lucas
AU - Morrow, C. Paul
PY - 2009/7
Y1 - 2009/7
N2 - 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.
AB - 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.
KW - Cervical cancer
KW - Gynecologic malignancies
KW - Gynecologic surgery
KW - Pelvic exenteration
KW - Radical surgery
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U2 - 10.1016/j.ygyno.2009.03.029
DO - 10.1016/j.ygyno.2009.03.029
M3 - Article
C2 - 19411097
AN - SCOPUS:67349239896
VL - 114
SP - 64
EP - 68
JO - Gynecologic Oncology
JF - Gynecologic Oncology
SN - 0090-8258
IS - 1
ER -