Document Type : Original Research Article
Authors
1 FRCOG(UK) Senior Consultant O&G Head of Department O&G International Medical University
2 MB.BS, M.Med (O&G), FICS (USA), FACS(USA), FRSPH(UK)
3 FRCOG(UK) International Medical University
4 MBBS (UM), DrObGyn(UKM) Obstetrician & Gynaecologist Hospital Ampang, Malaysia
Abstract
Pelvic exenteration (PE) is a surgical procedure that requires an en-bloc excision of lower abdominopelvic structures. Despite its high morbidity, PE is most indicated for treatment of advanced primary or locally recurrent pelvic cancers. We aim to evaluate our experience with PE for patients with gynaecological cancers over 8 years from January 2011 to 31 December 2019 that were identified through hospital databases. Patient demographic characteristics, indications, surgical characteristics and outcomes were retrospectively assessed. Overall survival (OS) was analysed with Kaplan-Meier method and log rank test. Cox proportional hazards regression was used to model survival outcomes. Twenty- one patients were identified with recurrent cervical, endometrial, ovarian and, or vaginal cancer underwent PE. Local disease recurrence was the most common indication in 80.9%. The primary tumor origin was the cervix in 80.9%, followed by endometrial origin 9.5%. PE was performed as curative intent in 62% and in 38% as palliative intent. The most common early complication was wound infections and late complications included deep vein thrombosis, lymphocyst and recurrent urinary tract infections. The median survival at 6 months is 85.7% and 12 months is 57.1 %. Our five-year OS was 54.3 % (95% CI 34.2, 74.6). Our case series illustrates pelvic exenteration provides about 54.3% of 5-year survival chance in a selected group of patients. The early-and late complications rate are similar to those described historically. Pelvic exenteration results in sustained survival in selected patients and continued efforts must focus on identifying those patients who could potentially benefit most from PE.
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