Pelvic Exenterations for Cervical Cancer Recurrences—a Safe Option in Indian Scenario

Abstract

Cervical cancer is still a major health problem in India with majority of patients presenting with locally advanced stages. Management of local recurrences of cervical cancer after chemoradiation is a challenging task. Pelvic exenteration is a radical surgery with en bloc resection of pelvic organs is an accepted treatment modality for local recurrence of cervical cancer. In a low-resource country like India where alternate treatment modalities like chemotherapy and targeted therapy are unaffordable to these patients, this radical surgery may be the only treatment modality which gives long-term survival benefit. The aim of the study is to evaluate the morbidity and survival outcome following pelvic exenteration in patients with recurrent cervical cancer in our institution. After obtaining institutional review board approval, a retrospective audit was conducted of all patients who underwent pelvic exenterative surgery for recurrent cervical cancer in our institution from January 2007 to December 2017. The parameters assessed were age of the patient, histologic type and grade, stage of disease, surgical procedures performed, type of reconstruction, intra-operative complications, length of hospital stay, and post-operative morbidity. Patients were followed until March 2017. Survival time was calculated from the date of surgery to the date of last contact or death. Survival estimation was done by Kaplan-Meier method. Between 2007 and 2017, 30 patients underwent the surgery. Mean age of the cohort was 50.9 years (range 33–67 years). Histological type was squamous cell carcinoma in 23 and adenocarcinoma in 7 patients. Twelve patients had anterior exenteration, one had posterior and 17 had total exenteration. The mean operating time was 367.3 min (210–600 min). No post-operative mortality was observed. Post-operative complications were seen in 66.6% of which the most common was of the urinary tract including 4 patients with recurrent urosepsis, one patient with obstructive uropathy and acute renal failure necessitating laparotomy and ureteric reimplantation. Two patients developed fistulae, one urinary and one bowel. Median follow-up time was 27.5 months (1.8–99.1 months). A five-year overall survival for the cohort was 60.5%. It is suggested that pelvic exenteration is an effective technique with reasonable long-term survival benefit and acceptable morbidity in selected patients with cervical cancer recurrence.