Pelvic Exenteration for Recurrent Pelvic Cancer

Abstract

The first half of the 20th century ushered in an era of refinement in anesthetic and perioperative management that encouraged a more aggressive approach to extirpative surgery for malignancy. In 1948, Brunschwig was the first to publish the feasibility of en-bloc resection of the pelvic viscera. Subsequently, Brunschwig and Daniel1 reported their series of 592 pelvic exenterations. Despite a large number of cases, allowing these pioneers to gain a fairly robust familiarity with the procedure, surgical complications were frequent, mortality was substantial, and survival was limited. This initial series of pelvic exenteration demonstrated an operative mortality of 23% and a 5-year survival of only 17%.2 Thus, from these early reports a clear paradigm emerged; patients in whom complete tumor resection was not feasible gained no survival benefit with an exenterative procedure. With continued refinement of preoperative and operative management, as well as more stringent patient selection criteria, the past five decades have witnessed a substantial improvement in outcome. Most recent institutional series now report operative mortality under 5%, with 5-year survival approximating 50% (Table 7.1). The procedure is now widely accepted as the treatment of choice for a small, select subset of women with recurrent malignancy when it affords the only chance for cure.