title: Posterior pelvic exenteration and retrograde total hysterectomy in patients with locally advanced ovarian cancer: Clinical and functional outcome.
abstract: OBJECTIVE
  To evaluate clinical outcomes and postoperative quality of life in patients affected by locally advanced ovarian cancer who underwent pelvic posterior exenteration with Hudson-Delle Piane radical retrograde hysterectomy.
  
  
  METHODS
  Our study was done on a retrospective cohort using data from 22 patients who underwent surgery between 2010 and 2014 at the Gynecological Oncologic Center of Parma, Parma, Italy.
  
  
  RESULTS
  Residual disease after surgery (Sugarbacker index) was absent (CC-0) in 68% of cases. Tumor size was < 2.5 mm (CC-1) in 14% of cases and between 2.5 mm and 2.5 cm (CC-2) in 18% of cases. Complications during surgical procedure occurred in 64% of patients (14/22), but without severe consequences. Immediate postoperative complications (≤ 30 days) occurred in 82% of patients (18/22), and delayed complications (> 30 days) occurred in 23% (5/22) of patients. No patient died because of a complication. Urinary and rectal incontinence occurred in 5% and 16% of patients, respectively. Disease recurrence occurred in 58% of patients, median disease-free survival was 14 months (range, 6-36 months), and median overall survival was 21 months (range, 6-42 months).
  
  
  CONCLUSIONS
  Our study confirmed that pelvic posterior exenteration associated with retrograde radical hysterectomy represents the safest radical surgical approach to advanced ovarian cancer, which permits preservation of the pelvic autonomic nerve plexus and, therefore, bladder and colorectal functions.
authors.affiliation: Department of Obstetric and Gynaecology, Gynaecologic Oncology Unit, Parma University Hospital, Parma, Italy. Electronic address: roberto.berrettamd@gmail.com.
authors.forename: Roberto
authors.initials: R
authors.lastname: Berretta
authors.affiliation: Department of Surgical Sciences, Parma University Hospital, Parma, Italy.
authors.forename: Federico
authors.initials: F
authors.lastname: Marchesi
authors.affiliation: Department of Obstetric and Gynaecology, Gynaecologic Oncology Unit, Parma University Hospital, Parma, Italy.
authors.forename: Lavinia
authors.initials: L
authors.lastname: Volpi
authors.affiliation: Department of Obstetric and Gynaecology, Gynaecologic Oncology Unit, Parma University Hospital, Parma, Italy.
authors.forename: Giulio
authors.initials: G
authors.lastname: Ricotta
authors.affiliation: Department of Obstetric and Gynaecology, Gynaecologic Oncology Unit, Parma University Hospital, Parma, Italy.
authors.forename: Michela
authors.initials: M
authors.lastname: Monica
authors.affiliation: Department of Obstetric and Gynaecology, Gynaecologic Oncology Unit, Parma University Hospital, Parma, Italy.
authors.forename: Giulio
authors.initials: G
authors.lastname: Sozzi
authors.affiliation: Department of Obstetric and Gynaecology, Gynaecologic Oncology Unit, Parma University Hospital, Parma, Italy.
authors.forename: Maurizio
authors.initials: M
authors.lastname: Di Serio
authors.affiliation: Department of Obstetric and Gynaecology, Gynaecologic Oncology Unit, Parma University Hospital, Parma, Italy.
authors.forename: Daniele
authors.initials: D
authors.lastname: Mautone
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D000077216:Carcinoma, Ovarian Epithelial; D018572:Disease-Free Survival; D005242:Fecal Incontinence / Q000209:etiology*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007044:Hysterectomy / Q000009:adverse effects* / Q000379:methods; D007431:Intraoperative Complications / Q000209:etiology; D008875:Middle Aged; D018365:Neoplasm, Residual; D009375:Neoplasms, Glandular and Epithelial / Q000473:pathology* / Q000601:surgery*; D010051:Ovarian Neoplasms / Q000473:pathology* / Q000601:surgery*; D010385:Pelvic Exenteration / Q000009:adverse effects* / Q000379:methods; D011183:Postoperative Complications / Q000209:etiology; D011788:Quality of Life; D012189:Retrospective Studies; D015996:Survival Rate; D013997:Time Factors; D047368:Tumor Burden; D014549:Urinary Incontinence / Q000209:etiology*
keywords: bladder colorectal function; cytoreductive surgery; ovarian cancer; posterior pelvic exenteration