Exenterations 60 years after first description: results of a survey among US and German Gynecologic Oncology Centers.
OBJECTIVE
Sixty years after exenterative surgery was introduced into gynecologic oncology, the indications and contraindications, techniques, and adjuvant therapies after exenteration are controversially discussed between gynecologic oncologists.


METHODS
To evaluate the current patterns of care, a questionnaire with 48 items was sent to 40 Society of Gynecologic Oncologists member clinics with fellowship programs and all 38 German teaching hospitals for gynecologic oncology.


RESULTS
The mean number of exenterations performed during the last 5 years was comparable in both countries. Consistently, (central) recurrent cervical cancer or persistent tumor after chemoradiation is the main indication. Before exenteration, positron emission tomography-computed tomography is mostly performed in the United States, whereas magnetic resonance imaging is the preferred imaging tool in Germany. Staging is more often done surgically in the United States (61%) compared with Germany (32%). None of the US institutions recommend an exenteration for patients with International Federation of Gynecology and Obstetrics stage IVA in contrast to 43% in Germany. In the case of fistula to the bladder and/or rectum, exenteration was recommended only by 29% and 61% in US and German clinics, respectively. In Germany, interdisciplinarity with general surgeons, urologists, plastic surgeons, and radio-oncologists is more common. There is consensus to apply adjuvant therapy after exenteration in patients with positive margins and/or positive lymph nodes. However, adjuvant therapy is more frequently recommended in Germany (93%) than in the United States (74%).


CONCLUSIONS
Our data reflect considerable differences about indications and contraindications, preoperative staging, and adjuvant therapy for pelvic exenteration between Germany and the United States.
Marnitz
Simone
S
Department of Radiooncology, Charité Universitätsmedizin Berlin, Berlin, Germany.
Dowdy
Sean
S
Lanowska
Malgorzata
M
Schneider
Achim
A
Podratz
Karl
K
Köhler
Christhardt
C
D005260:Female; D005858:Germany / Q000453:epidemiology; D006801:Humans; D010385:Pelvic Exenteration / Q000639:trends*; D011183:Postoperative Complications / Q000517:prevention & control*; D011379:Prognosis; D011795:Surveys and Questionnaires; D015996:Survival Rate; D016896:Treatment Outcome; D014481:United States / Q000453:epidemiology; D002583:Uterine Cervical Neoplasms / Q000401:mortality / Q000601:surgery*