title: (Laterally) extended endopelvic resection: surgical treatment of locally advanced and recurrent cancer of the uterine cervix and vagina based on ontogenetic anatomy.
abstract: OBJECTIVE
  Pelvic exenteration is mainly applied as a salvage operation for a subset of patients with persistent and recurrent cervicovaginal cancer. The procedure can also cure locally advanced primary disease not suitable for radiotherapy. However, high operative abortion and intralesional tumor resection rates significantly limit its clinical benefit. To improve locoregional tumor control we have proposed to establish cancer surgery on ontogenetic anatomy and, consequently, we have developed the (Laterally) Extended Endopelvic Resection ((L)EER).
  
  
  METHODS
  (L)EER is clinically and histopathologically evaluated with a monocentric prospective observational study. Patients with advanced and recurrent cervicovaginal cancer are treatment candidates if distant metastases and tumor fixation at the region of the sciatic foramen can be excluded.
  
  
  RESULTS
  91 patients with locally advanced primary (n=30) and recurrent or persistent (n=61) carcinoma of the cervix and vagina were treated with (L)EER. 74% of the tumors were fixed to the pelvic wall. No (L)EER treatment was aborted, R0 resection was histopathologically confirmed in all cases. (L)EER definitively controlled the locoregional cancer in 92% (95% CI: 85-99) of the patients. Five year overall survival probability was 61% (95% CI: 49-72).
  
  
  CONCLUSIONS
  The results of (L)EER treatment confirm the concept of cancer surgery based on ontogenetic anatomy. In patients with locally advanced and recurrent cervicovaginal cancer (L)EER achieves locoregional tumor control both with central disease and with tumors fixed to the pelvic side wall except at the region of the sciatic foramen.
authors.affiliation: Department of Gynecology, University of Leipzig, Leipzig, Germany. michael.hoeckel@uniklinik-leipzig.de
authors.forename: Michael
authors.initials: M
authors.lastname: Höckel
authors.forename: Lars-Christian
authors.initials: LC
authors.lastname: Horn
authors.forename: Jens
authors.initials: J
authors.lastname: Einenkel
mesh_terms: D000328:Adult; D000368:Aged; D018196:Carcinoma, Adenosquamous / Q000401:mortality / Q000473:pathology / Q000601:surgery*; D018278:Carcinoma, Neuroendocrine / Q000401:mortality / Q000473:pathology / Q000601:surgery*; D002294:Carcinoma, Squamous Cell / Q000401:mortality / Q000473:pathology / Q000601:surgery*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local / Q000401:mortality / Q000601:surgery*; D009367:Neoplasm Staging; D018579:Patient Selection; D010385:Pelvic Exenteration / Q000379:methods*; D010388:Pelvis / Q000033:anatomy & histology / Q000196:embryology / Q000601:surgery; D011446:Prospective Studies; D016019:Survival Analysis; D016896:Treatment Outcome; D002583:Uterine Cervical Neoplasms / Q000401:mortality / Q000473:pathology / Q000601:surgery*; D014625:Vaginal Neoplasms / Q000401:mortality / Q000473:pathology / Q000601:surgery*