Skip to main content
SpringerLink
Log in

Does Histologic Type Correlate to Outcome after Pelvic Exenteration for Cervical and Vaginal Cancer?

  • Gynecologic Oncology
  • Published:
Annals of Surgical Oncology Aims and scope Submit manuscript

Abstract

Background

Adenocarcinoma (AC) of the cervix comprises 15–20 % of all cervical carcinomas, and data regarding the prognostic value of histologic type after pelvic exenteration (PE) are lacking. Our aim was to analyze the prognostic value of histologic type in overall survival (OS) and disease-specific survival (DSS) after PE and correlate it to clinical and pathologic variables.

Methods

We reviewed a series of 77 individuals who underwent PE for cervical or vaginal cancer from January 1980 to December 2010.

Results

Mean age was 54.5 years. Fifty-three patients (68.9 %) had cervical and 24 (31.1 %) vaginal cancer. Fifty-six (72.7 %) were squamous cell carcinoma (SCC) and 21 (27.3 %) ACs. We performed 42 (54.5 %) total, 18 anterior, 8 posterior, and 9 lateral extended PE. Median tumor size was 5 cm. Surgical margins were negative in 91.7 % of cases. Median operative time, length of hospital stay, and blood transfusion volume were, respectively, 420 (range 180–720) mins, 13.5 (range 4–79) days, and 900 (range 300–3900) ml. Median follow-up was 13.7 (range 1.09–114.3) months. SCC statistically correlated with presence of perineural invasion (p = 0.004). Five-year OS and DSS were, respectively, 24.4 and 37.1 %. SCC (p = 0.003) and grade 3 (p = 0.001) negatively affected OS in univariate analysis. SCC (p = 0.006), grade 3 (p = 0.003), perineural invasion (p = 0.03), lymph node metastasis (p = 0.02), and positive margins (p = 0.04) negatively affected DSS in univariate analysis. SCC and grade 3 retained the higher risk of death (OS and DSS) in multivariate analysis.

Conclusions

AC histology in cervical and vaginal cancer is associated with better outcome after PE compared to SCC.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2

Similar content being viewed by others

References

  1. Jemal A, Bray F, Center MM, Ferlay J, Ward E, Forman D. Global cancer statistics. CA Cancer J Clin. 2011;61:69–90.

    Article  PubMed  Google Scholar 

  2. Sasieni P, Adams J. Changing rates of adenocarcinoma and adenosquamous carcinoma of the cervix in England. Lancet. 2001;357:1490–3.

    Article  PubMed  CAS  Google Scholar 

  3. Bray F, Carstensen B, Møller H, et al. Incidence trends of adenocarcinoma of the cervix in 13 European countries. Cancer Epidemiol Biomark Prev. 2005;14:2191–9.

    Article  Google Scholar 

  4. Lai CH, Hsueh S, Hong JH, et al. Are adenocarcinomas and adenosquamous carcinomas different from squamous carcinomas in stage IB and II cervical cancer patients undergoing primary radical surgery? Int J Gynecol Cancer. 1999;9:28–36.

    Article  PubMed  Google Scholar 

  5. Eifel PJ, Morris M, Oswald MJ, Wharton JT, Delclos L. Adenocarcinoma of the uterine cervix: prognosis and patterns of failure in 367 cases. Cancer. 1990;65:2507–14.

    Article  PubMed  CAS  Google Scholar 

  6. Sherman ME, Wang SS, Carreon J, Devesa SS. Mortality trends for cervical squamous and adenocarcinoma in the United States. Cancer. 2005;103:1258–64.

    Article  PubMed  Google Scholar 

  7. Smith HO, Tiffany MF, Qualls CR, Key CR. The rising incidence of adenocarcinoma relative to squamous cell carcinoma of the uterine cervix in the United States: a 24-year population-based study. Gynecol Oncol. 2000;78:97–105.

    Article  PubMed  CAS  Google Scholar 

  8. Castellsagué X, Díaz M, De Sanjosé S, et al. Worldwide human papillomavirus etiology of cervical adenocarcinoma and its cofactors: implications for screening and prevention. J Natl Cancer Inst. 2006;98:303–15.

    Article  PubMed  Google Scholar 

  9. Wang SS, Sherman ME, Hildesheim A, Lacey JV Jr, Devesa S. Cervical adenocarcinoma and squamous cell carcinoma incidence trends among white women and black women in the United States for 1976–2000. Cancer. 2004;100:1035–44.

    Article  PubMed  Google Scholar 

  10. Gien LT, Beauchemin MC, Thomas G. Adenocarcinoma: a unique cervical cancer. Gynecol Oncol. 2010;116:140–6.

    Article  PubMed  CAS  Google Scholar 

  11. Landoni F, Maneo A, Colombo A, et al. Randomized study of radical surgery versus radiotherapy for stage Ib–IIa cervical cancer. Lancet. 1997;350:535–40.

    Article  PubMed  CAS  Google Scholar 

  12. Morris M, Eifel PJ, Lu J, et al. Pelvic radiation with concurrent chemotherapy compared with pelvic and paraaortic radiation for high-risk cervical cancer. N Engl J Med. 1999;340:1137–43.

    Article  PubMed  CAS  Google Scholar 

  13. Sedlis A, Bundy BN, Rotman MZ, Lentz SS, Muderspach LI, Zaino RJ. A randomized trial of pelvic radiation therapy versus no further therapy in selected patients with stage 1b carcinoma of the cervix after radical hysterectomy and pelvic lymphadenectomy: a gynecologic oncology group study. Gynecol Oncol. 1999;73:177–83.

    Article  PubMed  CAS  Google Scholar 

  14. Keys HM, Bundy BN, Stehman FB, et al. Cisplatin, radiation, and adjuvant hysterectomy for bulky stage IB cervical carcinoma. N Engl J Med. 1999;340:1154–61.

    Article  PubMed  CAS  Google Scholar 

  15. Rose PG, Bundy BN, Watkins J, et al. Concurrent cisplatin-based chemotherapy and radiotherapy for locally advanced cervical cancer. N Engl J Med. 1999;340:1144–53.

    Article  PubMed  CAS  Google Scholar 

  16. Landoni F, Maneo A, Cormio G, et al. Class II versus class III radical hysterectomy in stage IB-IIA cervical cancer: a prospective randomized study. Gynecol Oncol. 2001;80:3–12.

    Article  PubMed  CAS  Google Scholar 

  17. Peters WA, Liu PY, Barrett RJ, et al. Concurrent chemotherapy and pelvic radiation therapy compared with pelvic radiation therapy alone as adjuvant therapy after radical surgery in high-risk early stage cancer of the cervix. J Clin Oncol. 2000;18:1606–13.

    PubMed  CAS  Google Scholar 

  18. Eifel PJ, Winter K, Morris M, et al. Pelvic irradiation with concurrent chemotherapy versus pelvic and para-aortic irradiation for high-risk cervical cancer: an update of radiation therapy oncology group trial (RTOG) 90-01. J Clin Oncol. 2004;22:872–80.

    Article  PubMed  Google Scholar 

  19. Monk BJ, Wang J, Im S, et al. Rethinking the use of radiation and chemotherapy after radical hysterectomy: a clinical–pathologic analysis of a Gynecologic Oncology Group/Southwest Oncology Group/Radiation Therapy Oncology Group trial. Gynecol Oncol. 2005;96:721–8.

    Article  PubMed  Google Scholar 

  20. Chemoradiotherapy for Cervical Cancer Meta-Analysis Collaboration. Reducing uncertainties about the effects of chemoradiotherapy for cervical cancer: a systematic review and meta-analysis of individual patient data from 18 randomized trials. J Clin Oncol. 2008;26:5802–12.

    Article  Google Scholar 

  21. Höckel M, Dornhöfer N. Pelvic exenteration for gynaecological tumours: achievements and unanswered questions. Lancet Oncol. 2006;7:837–47.

    Article  PubMed  Google Scholar 

  22. Brunschwig A. Complete excision of pelvic viscera for advanced carcinoma. Cancer. 1948;1:177–83.

    Article  PubMed  CAS  Google Scholar 

  23. Lawhead RA, Clark DG, Smith DH, Pierce VK, Lewis JL Jr. Pelvic exenteration for recurrent or persistent gynaecologic malignancies: a 10- year review of the Memorial-Sloan-Kettering Cancer Center experience (1972–1981). Gynecol Oncol. 1989;33:279–82.

    Article  PubMed  Google Scholar 

  24. Magrina JF, Stanhope CR, Waever AL. Pelvic exenterations: supralevator, infralevator, and with vulvectomy. Gynecol Oncol. 1997;64:130–5.

    Article  PubMed  CAS  Google Scholar 

  25. Morley GW, Hopkins MP, Lindenauer SM, Roberts JA. Pelvic exenteration, university of Michigan: 100 patients at 5 years. Obstet Gynecol. 1989;74:934–43.

    PubMed  CAS  Google Scholar 

  26. Shingleton HM, Soong SJ, Gelder MS, Hatch KD, Baker VV, Austin JM Jr. Clinical and histopathologic factors predicting recurrence and survival after pelvic exenteration for cancer of the cervix. Obstet Gynecol. 1989;73:1027–34.

    PubMed  CAS  Google Scholar 

  27. Symmonds RE, Pratt JH, Webb MJ. Exenterative operations: experience with 198 patients. Am J Obstet Gynecol. 1975;121:907–18.

    PubMed  CAS  Google Scholar 

  28. Rutledge F, Smith J, Wharton J, O’Quinn AG. Pelvic exenteration; analysis of 296 patients. Am J Obstet Gynecol. 1977;129:881–92.

    PubMed  CAS  Google Scholar 

  29. Roberts W, Cavanagh D, Bryson P, Lyman GH, Hewitt S. Major morbidity after pelvic exenteration: a seven year experience. Obstet Gynecol. 1987;69:617–21.

    PubMed  CAS  Google Scholar 

  30. Hatch KD, Gelder MS, Soong SJ, Baker VV, Shingleton HM. Pelvic exenteration with low rectal anastomosis: survival, complications, and prognostic factors. Gynecol Oncol. 1990;38:462–7.

    Article  PubMed  CAS  Google Scholar 

  31. Matthews C, Morris M, Burke T, Gershenson DM, Wharton JT, Rutledge FN. Pelvic exenteration in the elderly patient. Obstet Gynecol. 1992;79:773–7.

    PubMed  CAS  Google Scholar 

  32. Morris M, Alvarez RD, Kinney WK, Wilson TO. Treatment of recurrent adenocarcinoma of the endometrium with pelvic exenteration. Gynecol Oncol. 1996;60:288–91.

    Article  PubMed  CAS  Google Scholar 

  33. Miller B, Morris M, Rutledge F, et al. Aborted exenterative procedures in recurrent cervical cancer. Gynecol Oncol. 1993;50:94–9.

    Article  PubMed  CAS  Google Scholar 

  34. Maggioni A, Roviglione G, Landoni F, et al. Pelvic exenteration: ten-year experience at the European Institute of Oncology in Milan. Gynecol Oncol. 2009;114:64–8.

    Article  PubMed  Google Scholar 

  35. Sharma S, Odunsi K, Driscoll D, Lele S. Pelvic exenteration for gynecological malignancies: twenty-year experience at Rosewell Park Cancer Institute. Int J Gynecol Cancer. 2005;15:475–82.

    Article  PubMed  CAS  Google Scholar 

  36. Pawlik TM, Skibber JM, Miguel AR. Pelvic exenteration for advanced pelvic malignancies. Ann Surg Oncol. 2005;13:612–23.

    Article  Google Scholar 

  37. Houvenaeghel G, Moutardier V, Karsenty G, et al. Major complications of urinary diversion after pelvic exenteration for gynecologic malignancies: a 23-year mono-institutional experience in 124 patients. Gynecol Oncol. 2004;92:680–3.

    Article  PubMed  CAS  Google Scholar 

  38. Ketcham AS, Deckers PJ, Sugarbaker EV, Hoye RC, Thomas LB, Smith RR. Pelvic exenteration for carcinoma of the uterine cervix—a 15-year experience. Cancer. 1970;26:513–21.

    Article  PubMed  CAS  Google Scholar 

  39. Saunders N. Pelvic exenteration: by whom and for whom? Lancet. 1995;345:5–6.

    Article  PubMed  CAS  Google Scholar 

  40. Stanhope CR, Symmonds RE. Palliative exenteration—what, when, and why? Am J Obstet Gynecol. 1985;152:12–6.

    PubMed  CAS  Google Scholar 

  41. Guimaraes GC, Ferreira FO, Rossi BM, et al. Double-barreled wet colostomy is a safe option for simultaneous urinary and fecal diversion. Analysis of 56 procedures from a single institution. J Surg Oncol. 2006;93:206–11.

    Article  PubMed  Google Scholar 

  42. Shingleton HM, Bell MC, Fremgen A, et al. Is there really a difference in survival of women with squamous cell carcinoma, adenocarcinoma, and adenosquamous cell carcinoma of the cervix? Cancer. 1995;76:1948–55.

    Article  PubMed  CAS  Google Scholar 

  43. Grigsby PW, Perez CA, Kuske RR, et al. Adenocarcinoma of the uterine cervix: lack of evidence for a poor prognosis. Radiother Oncol. 1988;12:289–96.

    Article  PubMed  CAS  Google Scholar 

  44. Look KY, Brunetto VL, Clarke-Pearson DL, et al. An analysis of cell type in patients with surgically staged stage IB carcinoma of the cervix: a gynecologic oncology group study. Gynecol Oncol. 1996;63:304–11.

    Article  PubMed  CAS  Google Scholar 

  45. Lee KBM, Lee JM, Park CY, Lee KB, Cho HY, Ha SY. What is the difference between squamous cell carcinoma and adenocarcinoma of the cervix? A matched case–control study. Int J Gynecol Cancer. 2006;16:1569–73.

    Article  PubMed  Google Scholar 

  46. Kilgore LC, Soong SJ, Gore H, Shingleton HM, Hatch KD, Partridge EE. Analysis of prognostic features in adenocarcinoma of the cervix. Gynecol Oncol. 1998;31:137–48.

    Article  Google Scholar 

  47. Alfsen GC, Kristensen GB, Skovlund E, Pettersen EO, Abeler VM. Histologic subtype has minor importance for overall survival in patients with adenocarcinoma of the uterine cervix: a population-based study of prognostic factors in 505 patients with nonsquamous cell carcinomas of the cervix. Cancer. 2001;92:2471–83.

    Article  PubMed  CAS  Google Scholar 

  48. Eifel PJ, Burke TW, Morris M, Smith TL. Adenocarcinoma as an independent risk factor for disease recurrence in patients with stage 1B cervical carcinoma. Gynecol Oncol. 1995;59:38–44.

    Article  PubMed  CAS  Google Scholar 

  49. Hopkins MP, Morley GW. A comparison of adenocarcinoma and squamous cell carcinoma of the cervix. Obstet Gynecol. 1991;77:912–7.

    PubMed  CAS  Google Scholar 

  50. Berek JS, Hacker NS, Fu YS, Sokale JR, Leuchter RC, Lagasse LD. Adenocarcinoma of the uterine cervix: histologic variables associated with lymph node metastasis and survival. Obstet Gynecol. 1985;65:46–52.

    PubMed  CAS  Google Scholar 

  51. Kleine W, Rau K, Schwoeorer D, Pfleiderer A. Prognosis of adenocarcinoma of the cervix uteri: a comparative study. Gynecol Oncol. 1989;35:145–59.

    Article  PubMed  CAS  Google Scholar 

  52. Chen RJ, Lin YH, Chen CA, Huang SC, Chow SN, Hsieh CY. Influence of histologic type and age on survival rates for invasive cervical carcinoma in Taiwan. Gynecol Oncol. 1999;73:184–90.

    Article  PubMed  CAS  Google Scholar 

  53. Davy MLJ, Dodd TJ, Luke CJ, Roder DM. Cervical cancer: effect of glandular cell type on prognosis, treatment, and survival. Obstet Gynecol. 2003;101:38–45.

    Article  PubMed  Google Scholar 

  54. Nakanishi T, Ishikawa H, Suzuki Y, Inoue T, Nakamura S, Kuzuya K. A comparison of prognoses of pathologic stage IB adenocarcinoma and squamous cell carcinoma of the uterine cervix. Gynecol Oncol. 2000;79:289–93.

    Article  PubMed  CAS  Google Scholar 

  55. Irie T, Kigawa J, Minagawa Y, et al. Prognosis and clinicopathological characteristics of Ib-IIb adenocarcinoma of the uterine cervix in patients who have had radical hysterectomy. Eur J Surg Oncol. 2000;26:464–7.

    Article  PubMed  CAS  Google Scholar 

  56. Takeda N, Sakuragi N, Takeda M, et al. Multivariate analysis of histopathologic prognostic factors for invasive cervical cancer treated with radical hysterectomy and systematic retroperitoneal lymphadenectomy. Acta Obstet Gynecol Scand. 2002;81:1144–51.

    Article  PubMed  Google Scholar 

  57. Galic V, Herzog TJ, Lewin SN, et al. Prognostic significance of adenocarcinoma histology in women with cervical cancer. Gynecol Oncol. 2012;125:287–91.

    Article  PubMed  Google Scholar 

  58. Crozier M, Morris M, Levenback C, Lucas KR, Atkinson EN, Wharton JT. Pelvic exenteration for adenocarcinoma of the uterine cervix. Gynecol Oncol. 1995;58:74–8.

    Article  PubMed  CAS  Google Scholar 

  59. 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;125:604–9.

    Article  PubMed  Google Scholar 

  60. Barakat RR, Goldman NA, Patel DA, Venkatraman ES, Curtin JP. Pelvic exenteration for recurrent endometrial cancer. Gynecol Oncol. 1999;75:99–102.

    Article  PubMed  CAS  Google Scholar 

  61. Marnitz S, Köhler C, Müller M, Behrens K, Hasenbein K, Schneider A. Indications for primary and secondary exenterations in patients with cervical cancer. Gynecol Oncol. 2006;103:1023–30.

    Article  PubMed  Google Scholar 

  62. Rutledge FN, McGuffee VB. Pelvic exenteration: prognostic significance of regional lymph node metastasis. Gynecol Oncol. 1987;26:347–80.

    Article  Google Scholar 

  63. Drescher CW, Hopkins MP, Roberts JA. Comparison of the pattern of metastatic spread of squamous cell cancer and adenocarcioma of the uterine cervix. Gynecol Oncol. 1989;33:340–3.

    Article  PubMed  CAS  Google Scholar 

  64. Rose PG. Are the differences in treatment outcome for adenocarcinoma of the cervix different enough to change the treatment paradigm? Gynecol Oncol. 2012;125:285–6.

    Article  PubMed  Google Scholar 

  65. Fotopoulou C, Neumann U, Kraetschell R, et al. Long-term clinical outcome of pelvic exenteration in patients with advanced gynecological malignancies. J Surg Oncol. 2010;101:507–12.

    Article  PubMed  Google Scholar 

Download references

Conflict of interest

The authors declare that there is no conflict of interest

Author information

Authors and Affiliations

  1. Department of Gynecologic Oncology, AC Camargo Cancer Hospital, Sao Paulo, Brazil

    Glauco Baiocchi MD, PhD, Carlos Chaves Faloppa MD, MSc & Lillian Yuri Kumagai MD, MSc

  2. Department of Pelvic Surgery, AC Camargo Cancer Hospital, Sao Paulo, Brazil

    Gustavo Cardoso Guimaraes MD, PhD, Renato Almeida Rosa Oliveira MD & Ademar Lopes MD, PhD

  3. Department of Pathology, AC Camargo Cancer Hospital, Sao Paulo, Brazil

    Maria Dirlei Begnami MD, PhD & Fernando Augusto Soares MD, PhD

Authors
  1. Glauco Baiocchi MD, PhD
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Gustavo Cardoso Guimaraes MD, PhD
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Carlos Chaves Faloppa MD, MSc
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Lillian Yuri Kumagai MD, MSc
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Renato Almeida Rosa Oliveira MD
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Maria Dirlei Begnami MD, PhD
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Fernando Augusto Soares MD, PhD
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. Ademar Lopes MD, PhD
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Glauco Baiocchi MD, PhD.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Baiocchi, G., Guimaraes, G.C., Faloppa, C.C. et al. Does Histologic Type Correlate to Outcome after Pelvic Exenteration for Cervical and Vaginal Cancer?. Ann Surg Oncol 20, 1694–1700 (2013). https://doi.org/10.1245/s10434-012-2768-6

Download citation

  • Received:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1245/s10434-012-2768-6

Keywords

Search

Navigation