title: Pelvic exenteration in gynecologic oncology: a single institution study over 20 years.
abstract: OBJECTIVE
  The profile of women with gynecologic malignancies treated with pelvic exenteration has changed since the initial description of this procedure. We sought to evaluate our experience with pelvic exenteration over the last 20 years.
  
  
  METHODS
  Patients who underwent anterior, posterior, or total pelvic exenteration for vulvar, vaginal, and cervical cancer at Barnes-Jewish Hospital between January 1, 1990 and August 1, 2009 were identified through hospital databases. Patient characteristics, the indications for the procedure, procedural modifications, and patient outcomes were retrospectively assessed. Categorical variables were analyzed with chi-square method, and survival data was analyzed using the Kaplan-Meier method and log rank test.
  
  
  RESULTS
  Fifty-four patients were identified who had pelvic exenteration for cervical, vaginal, or vulvar cancer. Recurrent cervical cancer was the most common procedural indication. One year overall survival from pelvic exenteration for the entire cohort was 64%, with 44% of patients still living at 2 years and 34% at 50 months. Younger age was associated with improved overall survival after exenteration (p = 0.01). Negative margin status was associated with a longer disease-free survival (p=0.014). Nodal status at the time of exenteration was not associated with time to recurrence or progression, site of recurrence, type of post-operative treatment, early or late complications, or survival.
  
  
  CONCLUSIONS
  Despite advances in imaging and increased radical techniques, outcomes and complications after total pelvic exenteration in this cohort are similar to those described historically. Pelvic exenteration results in sustained survival in select patients, especially those that are young with recurrent disease and pathologically negative margins.
authors: Department of Obstetrics and Gynecology, Division of Gynecologic Oncology, Washington University School of Medicine, USA. bennt@wudosis.wustl.edu
authors: T
authors: T
authors: Benn
authors: R A
authors: RA
authors: Brooks
authors: Q
authors: Q
authors: Zhang
authors: M A
authors: MA
authors: Powell
authors: P H
authors: PH
authors: Thaker
authors: D G
authors: DG
authors: Mutch
authors: I
authors: I
authors: Zighelboim
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D005833:Genital Neoplasms, Female / Q000601:surgery*; D006801:Humans; D008875:Middle Aged; D010385:Pelvic Exenteration; D012189:Retrospective Studies; D015996:Survival Rate; D055815:Young Adult