title: Extended pelvic resections for recurrent or persistent uterine and cervical malignancies: an update on out of the box surgery.
abstract: OBJECTIVE
  To update our report on the outcome of patients who underwent extended pelvic resection (EPR) for recurrent or persistent uterine and cervical malignancies.
  
  
  METHODS
  We reviewed the records of all patients who underwent EPR between 6/2000 and 07/2011. EPR was defined as an en-bloc resection of a pelvic tumor with sidewall muscle, bone, major nerve, and/or major vascular structure. Complications up to 180 days post surgery were analyzed. Survivals were estimated using the Kaplan-Meier method.
  
  
  RESULTS
  We identified 22 patients. Median age at the time of EPR was 58 years (range, 36-74). Median tumor diameter was 5.4 cm (range, 1.5-11.2). Primary tumor sites included: uterus, 13; cervix, 7; synchronous uterus/cervix, 1; and synchronous uterus/ovary, 1. The EPR structures were: muscle, 13; nerve, 10; bone, 8; vessel, 5. Complete gross resection with microscopically negative margins (R0 resection) was achieved in 17 patients (77%). There were no perioperative mortalities. Major postoperative complications occurred in 14 patients (64%). The two most common morbidities were pelvic abscesses and peripheral neuropathies. Median follow-up time was 28 months (range, 6-99). The 5-year overall survival (OS) for the entire cohort was 34% (95% CI, 13-57). For the 17 patients who had an R0 resection, the 5-year OS was 48% (95% CI, 19-73). In patients with positive pathologic margins (n=5), the 5-year OS was 0%.
  
  
  CONCLUSIONS
  EPR was associated with prolonged survival when an R0 resection was achieved. The high rate of postoperative complications remains a hallmark of these procedures and properly selected patients should be extensively counseled preoperatively.
authors.affiliation: Gynecology Service, Department of Surgery, Memorial Sloan-Kettering Cancer Center, 1275 York Avenue, New York, NY 10065, USA.
authors.forename: V
authors.initials: V
authors.lastname: Andikyan
authors.forename: F
authors.initials: F
authors.lastname: Khoury-Collado
authors.forename: Y
authors.initials: Y
authors.lastname: Sonoda
authors.forename: S R
authors.initials: SR
authors.lastname: Gerst
authors.forename: K M
authors.initials: KM
authors.lastname: Alektiar
authors.forename: J S
authors.initials: JS
authors.lastname: Sandhu
authors.forename: B H
authors.initials: BH
authors.lastname: Bochner
authors.forename: R R
authors.initials: RR
authors.lastname: Barakat
authors.forename: P J
authors.initials: PJ
authors.lastname: Boland
authors.forename: D S
authors.initials: DS
authors.lastname: Chi
mesh_terms: D000328:Adult; D000368:Aged; D005260:Female; D006801:Humans; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local / Q000473:pathology / Q000601:surgery; D009367:Neoplasm Staging; D010385:Pelvic Exenteration / Q000009:adverse effects / Q000379:methods*; D015996:Survival Rate; D016896:Treatment Outcome; D002583:Uterine Cervical Neoplasms / Q000473:pathology / Q000601:surgery*; D014594:Uterine Neoplasms / Q000473:pathology / Q000601:surgery*