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Multivisceral surgery for advanced gynaecological malignancies

Multiviszerale Operationen bei fortgeschrittenen gynäkologischen Malignomen

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Summary

Background: The goal of this study was to determine whether multivisceral surgery for advanced primary or recurrent gynaecological malignancies has prognostic implications with regard to operative features, morbidity, quality of life, and survival.

Methods: Between January 1991 and January 2000, we treated 48 patients suffering from advanced gynaecological tumours (except ovarian cancer) with 60 ultraradical surgical procedures. The most common indication for operation was recurrent cervical cancer (75%).

Results: Macroscopically tumour-free situation (29%) after surgery represents the most important prognostic parameter. In our study, these patients and those with residual tumours of less than 2 cm in diameter (34%) had a median survival time of 12 months; those with a larger lesion (32%), only 5.5 months. The postoperative complications are representative of those associated with any major cancer operation. Two patients died within 30 days postoperatively. Half of the patients reported a better quality of life.

Conclusions: Radical multivisceral surgery is feasible, safe and efficient for primary as well as for recurrent advanced gynaecological malignancies. It is justified also for complications of nonoperative therapy. The survival benefit for those patients in whom optimal surgical cytoreduction has been achieved is evident. Careful patient selection and complete interdisciplinary management are mandatory.

Zusammenfassung

Grundlagen: Ziel der vorliegenden Studie war es, zu analysieren, welchen Einfluß multiviszeralchirurgische Maßnahmen bei fortgeschrittenen primären und rezidivierten gynäkologischen Karzinomen auf die Morbidität, Lebensqualität und Überlebenszeit nehmen.

Methodik: Zwischen Januar 1991 und Januar 2000 behandelten wir 48 Patientinnen, die an fortgeschrittenen gynäkologischen Karzinomen erkrankt waren (ausgenommen Ovarialkarzinome) mit 60 ultraradikalen Operationen. Hauptindikation war das rezidivierte Zervixkarzinom (75%).

Ergebnisse: Die postoperative makroskopische Tumorfreiheit (29%) repräsentiert den wichtigsten Prognosefaktor. In unserer Studie hatten diese Patienten und jene mit Tumorresten, die kleiner als 2 cm waren (34%), ein medianes Überleben von 12 Monaten, Patienten mit einem größeren Tumorrest (32%) nur 5,5 Monate. Die postoperativen Komplikationen sind repräsentativ für die, die bei anderen multiviszeralchirurgischen Krebsoperationen durchgeführt werden. Zwei Patienten starben innerhalb von 30 Tagen nach der Operation. Die Hälfte gab eine Verbesserung ihrer Lebensqualität an.

Schlußfolgerungen: Multiviszeralchirurgische Eingriffe sind durchführbar, sicher und effizient sowohl beim primären als auch beim rezidivierten fortgeschrittenen gynäkologischen Karzinom. Sie sind auch gerechtfertigt bei Komplikationen nach nicht operativen Behandlungsverfahren. Der Überlebensvorteil der Patientinnen, bei denen ein optimales Tumordebulking erreicht wurde, ist eindeutig. Eine sorgfältige Patientenselektion und das frühzeitige interdisziplinäre Management sind von größter Bedeutung.

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Authors and Affiliations

  1. Department of Surgery, Charité, Campus Virchow Clinic, Humboldt University Berlin, Augustenburger Platz 1, D-13353, Berlin, Germany

    H. Weidemann M.D., K. P. Platz & P. Neuhaus

  2. the Department of Gynaecology and Obstetrics, Charité, Campus Virchow Clinic, Humboldt University Berlin, Germany

    A. Hieronimus-Reichel, J. Sehouli, E. Buchmann & W. Lichtenegger

  3. the Department of Urology, Charité, Campus Virchow Clinic, Humboldt University Berlin, Germany

    B. Heider & S. -A. Loening

Authors
  1. H. Weidemann M.D.
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  2. A. Hieronimus-Reichel
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  3. J. Sehouli
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  4. K. P. Platz
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  5. E. Buchmann
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  6. B. Heider
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  7. W. Lichtenegger
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  8. S. -A. Loening
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  9. P. Neuhaus
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Correspondence to H. Weidemann M.D..

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Dedicated Prof. Lichtenegger for his 60th birthday.

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Weidemann, H., Hieronimus-Reichel, A., Sehouli, J. et al. Multivisceral surgery for advanced gynaecological malignancies. Eur Surg 35, 102–105 (2003). https://doi.org/10.1046/j.1682-4016.2003.03046.x

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  • DOI: https://doi.org/10.1046/j.1682-4016.2003.03046.x

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