title: Pelvic exenteration for recurrent gynecologic malignancy: a study of 28 consecutive patients at a single institution.
abstract: OBJECTIVE
  The aim of this study was to assess the outcomes of patients undergoing pelvic exenteration (PE) for recurrent gynecologic malignancy.
  
  
  METHODS
  A retrospective review using all medical records of 28 consecutive patients who underwent PE between January 2002 and December 2011 at a single institution was conducted. Complications were graded according to Clavien-Dindo. Overall survival (OS) and disease-free survival (DFS) were estimated by the method of Kaplan-Meier.
  
  
  RESULTS
  Pelvic exenteration was performed for recurrent cancer in all patients. Distribution of primaries was as follows: cervix (n = 10), vagina (n = 5), ovary (n = 5), uterus (n = 4), tube (n = 2), Bartholin gland (n = 1), and vulva (n = 1). In all but 1 case, PE was performed with curative intent. Pelvic exenteration was total (n = 11), anterior (n = 2), or posterior (n = 15). Reconstructive procedures included urinary tract (n = 13), gastrointestinal tract (n = 26), pelvic floor (n = 6), and vagina (n = 5). There was no postoperative mortality within 30 days. All patients developed 1 or several early complications of various grades, and 22 patients (79%) developed late complications. Twelve patients (43%) underwent reoperation because of complications to PE, and 2 patients died within follow-up as a consequence of their PE. A complete tumor resection (R0) was obtained in 23 patients (82%). With a median follow-up of 27 months (range, 2-110 months), the 5-year OS and DFS rates were 70% and 41%, respectively. R0 resection was associated with increased OS (P < 0.001) and DFS (P = 0.015).
  
  
  CONCLUSIONS
  Pelvic exenteration for recurrent gynecologic malignancies can be associated with long-term survival in selected patients. However, postoperative complications are common and can be lethal.
authors: Division of Obstetrics and Gynecology, Department of Women's and Children's Health, Karolinska University Hospital, Stockholm, Sweden. linda_jager@yahoo.se
authors: Linda
authors: L
authors: Jäger
authors: Per J
authors: PJ
authors: Nilsson
authors: Angelique Flöter
authors: AF
authors: Rådestad
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D005833:Genital Neoplasms, Female / Q000401:mortality / Q000601:surgery*; D006801:Humans; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local / Q000401:mortality / Q000601:surgery*; D010385:Pelvic Exenteration / Q000009:adverse effects*; D012189:Retrospective Studies; D013548:Sweden / Q000453:epidemiology; D016896:Treatment Outcome