title: Pelvic exenteration for recurrent gynecologic malignancy: survival and morbidity analysis of the 45-year experience at UCLA.
abstract: OBJECTIVE
  To retrospectively assess the outcome of patients undergoing pelvic exenteration for recurrent or persistence gynecologic malignancy and the clinical features associated with outcome and survival.
  
  
  METHODS
  A review was conducted of patients who underwent pelvic exenteration over a 45-year period (1956-2001) at the UCLA Medical Center. Numerous clinical variables were analyzed, including time to relapse, type of exenteration and reconstructive operation, early (<60 days) and late (>60 days) morbidity, and survival. Variables were analyzed by chi-square and life-table analysis.
  
  
  RESULTS
  Seventy-five patients (ages 26-74 years) had persistent cervical and vaginal (67) and uterine (8) cancer. Forty-six patients underwent total exenteration, 23 anterior, and 6 posterior. Sixty-nine (92%) patients underwent urinary diversion or neocystoplasty, 54 (72%) patients had a simultaneous neovagina created, and 43 of 52 (83%) patients who had a low colon resection had a primary reanastomosis. Twenty-nine patients died from recurrent malignancy, 28 were alive without disease, 11 were alive with disease, and 7 died from other causes at last follow-up. Survival for patients with cervical and vaginal cancer was 73% at 1 year, 57% at 3 years, and 54% at 5 years. Survival for patients with uterine cancer was 86% at 1 year, 62% at 3 and 5 years. The most frequent early morbidity was urinary tract infection, wound infection, and intestinal fistula; the most frequent late morbidity was urinary tract infection and intestinal obstruction.
  
  
  CONCLUSIONS
  Pelvic exenteration in patients with recurrent cervical and vaginal malignancy is associated with a durable > 50% 5-year survival. Simultaneously performed pelvic reconstructive operations with a continent urinary diversion, the creation of a neovagina, and the reanastomosis of the colon with the formation of a J-pouch is now our standard; and these operations tend to improve the outcome of patients. Based on our initial experience, recurrent uterine corpus cancer in young women (< 55 years) should be included as an indication for the surgery.
authors.affiliation: Division of Gynecologic Oncology, David Geffen School of Medicine, University of California-Los Angeles, UCLA Center for the Health Sciences 24-127, 10833 LeConte Avenue, Los Angeles, CA 90095-1740, USA. jberek@mednet.ucla.edu
authors.forename: Jonathan S
authors.initials: JS
authors.lastname: Berek
authors.forename: Candace
authors.initials: C
authors.lastname: Howe
authors.forename: Leo D
authors.initials: LD
authors.lastname: Lagasse
authors.forename: Neville F
authors.initials: NF
authors.lastname: Hacker
mesh_terms: D000328:Adult; D000368:Aged; D016063:Blood Loss, Surgical; D005260:Female; D005833:Genital Neoplasms, Female / Q000453:epidemiology / Q000601:surgery*; D006801:Humans; D008875:Middle Aged; D009017:Morbidity; D009364:Neoplasm Recurrence, Local / Q000601:surgery; D010385:Pelvic Exenteration / Q000009:adverse effects; D019651:Plastic Surgery Procedures; D012189:Retrospective Studies; D015996:Survival Rate; D016896:Treatment Outcome