title: Anterior pelvic exenteration with total vaginectomy for recurrent or persistent genitourinary malignancies: review of surgical technique, complications, and outcome.
abstract: OBJECTIVE
  To describe the surgical technique, complications, and outcomes after anterior pelvic exenteration with total vaginectomy (AETV) for recurrent or persistent genitourinary malignancies.
  
  
  METHODS
  We reviewed the medical records of all patients who underwent AETV between 12/2002 and 07/2011. Relevant demographic, clinical, and pathological information was collected. Postoperative complications and rates of readmission and reoperation (up to 180 days after surgery) were examined, and preliminary survival data were obtained.
  
  
  RESULTS
  We identified 11 patients who underwent AETV. The median age at the time of the surgery was 55 years (range, 36-71). The median tumor size was 0.9 cm (range, microscopic - 4). Primary tumor sites included: cervix, 6; uterus, 3; vagina, 1; and urethra, 1. Complete surgical resection with negative pathologic margins was achieved in all 11 patients. Major postoperative complications occurred in 4 patients (36%). Six patients (55%) required readmission to the hospital. No operative mortalities were observed, and none of the patients required a re-operation. With a median follow-up after the procedure of 25 months (range, 6-95), none of the patients developed a pelvic recurrence. Ten patients (91%) were alive without evidence of disease and one patient (9%) developed a pancreatic recurrence.
  
  
  CONCLUSIONS
  AETV sparing the rectosigmoid and anus is feasible in highly selected patients with central pelvic recurrences. Compared to previously reported studies on total pelvic exenteration, data from this case series suggest that AETV may be associated with a lower rate of complications without compromising the oncologic outcome, while also preserving rectal function.
authors.affiliation: Gynecology Service, Department of Surgery, Memorial Sloan-Kettering Cancer Center, 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: S R
authors.initials: SR
authors.lastname: Gerst
authors.forename: S
authors.initials: S
authors.lastname: Talukdar
authors.forename: B H
authors.initials: BH
authors.lastname: Bochner
authors.forename: J S
authors.initials: JS
authors.lastname: Sandhu
authors.forename: N
authors.initials: N
authors.lastname: Abu-Rustum
authors.forename: Y
authors.initials: Y
authors.lastname: Sonoda
authors.forename: R R
authors.initials: RR
authors.lastname: Barakat
authors.forename: D S
authors.initials: DS
authors.lastname: Chi
mesh_terms: D000230:Adenocarcinoma / Q000473:pathology / Q000601:surgery*; D000328:Adult; D000368:Aged; D016063:Blood Loss, Surgical; D001803:Blood Transfusion; D002294:Carcinoma, Squamous Cell / Q000473:pathology / Q000601:surgery*; D017024:Chemotherapy, Adjuvant; D005260:Female; D006801:Humans; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local / Q000601:surgery*; D010359:Patient Readmission; D010385:Pelvic Exenteration / Q000009:adverse effects / Q000379:methods*; D018714:Radiotherapy, Adjuvant; D012189:Retrospective Studies; D013997:Time Factors; D014565:Urogenital Neoplasms / Q000473:pathology / Q000601:surgery*; D014621:Vagina / Q000601:surgery*