Abstract
In patients with locally recurrent cervical cancer, pelvic exenteration is a viable option with long-term survival in over one third of patients. Depending on the survival disease-free, the site and size of recurrence can be set 5-year survivals of 48–60%. Since it was first reported in 1948, pelvic exenteration has been used in the treatment of advanced pelvic cancers. The original procedure has been modified in an attempt to preserve urinary or fecal continence. The subclassification of the exenteration groups into type I (supralevator), type II (infralevator), and type III (with vulvectomy) is helpful to facilitate understanding of the extent of resection of the pelvic structures and the anatomical changes associated with each operation. Pelvic exenteration should only be undertaken by experienced surgeons at specialized centers. Restorative techniques for both urinary and gastrointestinal tracts can diminish the need for stomas and, along with vaginal reconstruction, can significantly improve quality of life for many patients afterexenteration. These advances in surgery and radiotherapy help make the procedure a viable option for patients with otherwise incurable elvic malignancy.
Access this chapter
Tax calculation will be finalised at checkout
Purchases are for personal use only
References
Höckel M, Dornhöfer N. Pelvic exenteration for gynaecological tumours: achievements and unanswered questions. Lancet Oncol. 2006;7(10):837–47.
Brunschwig A. Complete excision of pelvic viscera for abdominal carcinoma. Cancer. 1948;1:177–88.
Bricker EM. Bladder substitution after pelvic evisceration. Surg Clin North Am. 1950;30:1511–21.
Brunschwig A. What are the indications and results of pelvic exenteration? JAMA. 1965;194(3):274.
Brunschwig A, Barber HRK. Pelvic exenteration combined with resection of segments of bony pelvis. Surgery. 1969;65:417–20.
Magrina JF. Types of pelvic exenterations: a reappraisal. Gynecol Oncol. 1990;37:363–6.
Sevin B-U. Pelvic exenteration. Surg Clin North Am. 2001;81(4):771–80.
Kaur M, Joniau S, D’Hoore A, Vergote I. Indications, techniques and outcomes for pelvic exenteration in gynecological malignancy. Curr Opin Oncol. 2014;26(5):514–20.
Buchsbaum HJ, White AJ. Omental sling for management of the pelvic floor following exenteration. Am J Obstet Gynecol. 1973;117:407–12.
Soper JT, Berchuck A, Creasman WT, Clarke-Pearson DL. Pelvic exenteration: factors associated with major surgical morbidity. Gynecol Oncol. 1989;35:93–8.
Magrina JF et al. Pelvic Exenterations: supralevator, infralevator, and with vulvectomy. Gynecol Oncol. 1997;64:130–5.
Baiocchi G, Guimaraes GC, Oliveira RA, Kumagai LY, Faloppa CC, Aguiar S, Begnami MD, Soares FA, Lopes A. Prognostic factors in pelvic exenteration for gynecological malignancies. Eur J Surg Oncol. 2012;38(10):948–54.
Peiretti M et al. Management of recurrent cervical cancer: a review of the literature. Surg Oncol. 2012;21(2):59–66.
Landoni F et al. Neoadjuvant chemotherapy prior to pelvic exenteration in patients with recurrent cervical cancer: single institution experience. Gynecol Oncol. 2013;130(1):69–74.
Iglesias DA et al. The effect of body mass index on surgical outcomes and survival following pelvic exenteration. Gynecol Oncol. 2012;125:336–42.
Huang M, Iglesias DA, Westin SN, et al. Pelvic exenteration: impact of age on surgical and oncologic outcomes. Gynecol Oncol. 2014;132:114–8.
Turns D. Psychosocial issues: pelvic exenterative surgery. J Surg Oncol. 2001;76:224–36.
Kaur M, Joniau S, et al. Pelvic exenteration for gynecological malignancies: a study of 36 cases. Int J Gynecol Cancer. 2012;22:889–96.
Vargas H. Magnetic resonance imagin/ positron emission tomography provides a roadmap for surgical planning and serves as predictive biomarker in patients with recurrent gynecological cancer undergoing pelvic exenteration. Int J Gynecol Cancer. 2013;23(8):1512–9.
Rutledge FN, McGuffee VB. Pelvic exenteration: prognostic significance of regional lymph node metastasis. Gynecol Oncol. 1987;26(3):374–80.
Schmidt AM, Imesch P, Fink D, Egger H. Indications and long-term clinical outcomes in 282 patients with pelvic exenteration for advanced or recurrent cervical cancer. Gynecol Oncol. 2012;25(3):604–9.
Berek JS, Howe C, Lagasse LD, Hacker NF. Pelvic exenteration for recurrent gynecologic malignancy: survival and morbidity analysis of the 45-year experience at UCLA. Gynecol Oncol. 2005;99:153–9.
Höckel M, Horn LC, Einenkel J. (Laterally) extended endopelvic resection: surgical treatment of locally advanced and recurrent cancer of the uterine cervix and vagina based on ontogenetic anatomy. Gynecol Oncol. 2012;127(2):297–302.
Köhler C, Tozzi R, Possover M, Schneider A. Explorative laparoscopy prior to exenterative surgery. Gynecol Oncol. 2002;86(3):311–5.
Westin SN, Rallapalli V, Fellman B. Overall survival after pelvic exenteration for gynecologic malignancy. Gynecol Oncol. 2014;134(3):546–51.
Jurado M, Alcázar JL, Martinez-Monge R. Resectability rates of previously irradiated recurrent cervical cancer (PIRCC) treated with pelvic exenteration: is still the clinical involvement of the pelvis wall a real contraindication? a twenty-year experience. Gynecol Oncol. 2010;116(1):38–43.
Höckel M. Laterally extended endopelvic resection (LEER)--principles and practice. Gynecol Oncol. 2008;111(2 Suppl):S13–7.
Chiantera V, Rossi M, De Laco P. Morbidity after pelvic exenteration for gynecological malignancies: a retrospective multicentric study of 230 patients. Int J Gynecol Cancer. 2014;24(1):156–64.
Martínez A, Filleron T, Vitse L, Querleu D. Laparoscopic pelvic exenteration for gynaecological malignancy: is there any advantage? Gynecol Oncol. 2011;120(3):374–9.
Puntambekar S, Rajamanickam S. Laparoscopic posterior exenteration in advanced gynecologic malignant disease. J Minim Invasive Gynecol. 2011;18(1):59–63.
Hatch KD, Gelder MS, Soong SJ, et al. Pelvic exenteration with low rectal anastomosis: survival, complications, and prognostic factors. Gynecol Oncol. 1990;38:462–7.
Moutardier V, Houvenaeghel G, Lelong B. Colorectal function preservation in posterior and total supralevator exenteration for gynecologic malignancies: an 89-patient series. Gynecol Oncol. 2003;89(1):155–9.
Madersbacher S, Schmidt J, Eberle JM. Long-term outcome of ileal conduit diversion. J Urol. 2003;169(3):985–90.
Bloch WE, Bejany DE, Penalver MA, Politano VA. Complications of the Miami pouch. J Urol. 1992;147(4):1017–9.
Mirhashemi R, Im S, Yazdani T. Urinary diversion following radical pelvic surgery. Curr Opin Obstet Gynecol. 2004;16(5):419–22.
Salom EM, Mendez LE, Schey D, Lambrou N, Kassira N, Gómez-Marn O, Averette H, Peñalver M. Continent ileocolonic urinary reservoir (Miami pouch): the University of Miami experience over 15 years. Am J Obstet Gynecol. 2004;190(4):994–1003.
Park JY, Choi HJ, Jeong SY, Chung J, Park JK, Park SY. The role of pelvic exenteration and reconstruction for treatment of advanced or recurrent gynecologic malignancies: analysis of risk factors predicting recurrence and survival. J Surg Oncol. 2007;96(7):560–8.
Rezk YA, Hurley KE, Carter J, Dao F, Bochner BH, Aubey JJ, Caceres A, Einstein MH, Abu-Rustum NR, Barakat RR, Makker V, Chi DS. A prospective study of quality of life in patients undergoing pelvic exenteration: interim results. Gynecol Oncol. 2013;128(2):191–7.
Author information
Authors and Affiliations
Corresponding author
Editor information
Editors and Affiliations
Rights and permissions
Copyright information
© 2017 Springer International Publishing Switzerland
About this chapter
Cite this chapter
Montalvo-Esquivel, G., Pérez-Quintanilla, M.C., Herrera-Gómez, A., Alcalá-Prieto, F.J., Morales-Vásquez, F., Basave, H.N.L. (2017). Surgical Treatment for Advanced or Recurrent Disease in Cervical Cancer. In: de la Garza-Salazar, J., Morales-Vásquez, F., Meneses-Garcia, A. (eds) Cervical Cancer. Springer, Cham. https://doi.org/10.1007/978-3-319-45231-9_11
Download citation
DOI: https://doi.org/10.1007/978-3-319-45231-9_11
Published:
Publisher Name: Springer, Cham
Print ISBN: 978-3-319-45230-2
Online ISBN: 978-3-319-45231-9
eBook Packages: MedicineMedicine (R0)