(Laterally) Extended Endopelvic Resection for the Treatment of Locally Advanced and Recurrent Cervical Cancer

Abstract

Pelvic exenteration designating the en bloc resection of multiple pelvic organs is a time-honored salvage operation for a subset of patients with persistent and recurrent cervicovaginal cancer. The procedure which is based on conventional surgical anatomy 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 overcome these weaknesses, procedures termed (Laterally) Extended Endopelvic Resection ((L)EER) have been developed. Extended Endopelvic Resection extirpates multiple ontogenetic developmental instead of functional anatomical units such as the Müllerian, bladder, urogenital sinus compartments as well as the proximal urogenital mesentery. If indicated, the hindgut compartment can be included into the abdominal resection. To integrate the external urogenital sinus compartment, the procedure has to be performed abdominoperineally. Resection of the distal urogenital mesentery—necessary for the surgical treatment of disease fixed to the pelvic walls—mandates the inclusion of the internal iliac vessel system and/or pelvic wall and floor muscles. These procedures are termed Laterally Extended Endopelvic Resection (LEER).

(L)EER reliably achieves R0 resection in patients with locally advanced and recurrent cervicovaginal cancer if tumor fixation at the region of the sciatic foramen and peritoneal spread can be excluded.