Skip to main content
SpringerLink
Log in

Pelvic exenteration for recurrent or persistent cervical cancer

Experience of Five Years at the National Cancer Institute in Mexico

  • Original Article
  • Published:
Medical Oncology Aims and scope Submit manuscript

Abstract

Cervical cancer constitutes a major health problem in Mexico and other developing countries. The purpose of our study was to assess the experience of a comprehensive national oncological reference center on pelvic exenteration for post-radiotherapy recurrent or persistent cervical cancer, describing the prognostic value of time to recurrence, procedure complications, and survival. Medical records from 42 patients with post-radiotherapy recurrent or persistent cervical cancer who underwent a pelvic exenteration with curative purposes from 1984 to 1989 were retrospectively reviewed. Histological diagnoses were squamous cell carcinoma (32 patients), adenosquamous carcinoma (9 patients), and adenocarcinoma (1 patient). Average follow up was of 56.3 mo after the procedure and global survival at 5 yr was 65.8%. Survival for patients with early recurrence was 56.9% vs 78% for patients with late recurrence (p=0.05). Complications were observed in 65.3% of the cases with a surgical mortality of 4.8%. Pelvic exenteration is a surgical procedure with high morbidity in spite of the recent medical advances. Pelvic exenteration should not be indicated with palliative purposes owing to the high rate of complications. Patients with tumor persistence or early recurrence have a worse prognosis. In well-selected cases, exenteration may provide a survival benefit.

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

Similar content being viewed by others

References

  1. Dirección General de Epidemiología. Registro histopatológico de neoplasias en México. Morbilidad y mortalidad 2001. México: SSA, 2004.

    Google Scholar 

  2. Waggoner SE. Cervical cancer. Lancet 2003;361:2217–2225.

    Article  PubMed  Google Scholar 

  3. DiSaia PJ, Creasman WT. Clinical Gynecology Oncology, fifth Edition: 1997:51–106.

  4. Kuzuya K. Chemoradiotherapy for uterine cancer: current status and perspectives. Int J Clin Oncol 2004;9:458–470.

    Article  PubMed  Google Scholar 

  5. Long HJ, 3rd. Current research directions for locally advanced cervix cancer. Curr Oncol Rep 2003;5:468–472.

    PubMed  Google Scholar 

  6. Shibata K, et al. Usefulness of preoperative chemoradiation in locally advanced cervical carcinoma. Gynecol Obstet Invest 2004;57:93–99.

    Article  PubMed  Google Scholar 

  7. Vrdoljak E, Hamm W. Current state-of-the-art of concomitant chemoradiation in cervical carcinomas. Eur J Gynaecol Oncol 2003;24:475–479.

    PubMed  CAS  Google Scholar 

  8. Hockel M. Surgical treatment of locally advanced and recurrent cervical carcinoma: overview on current standard and new developments. Onkologie 2003;26:452–455.

    Article  PubMed  CAS  Google Scholar 

  9. 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;73:1027–1034.

    Article  PubMed  CAS  Google Scholar 

  10. Brunschwig A, Pierce VK. Partial and complete pelvic exenteration; a progress report based upon the first 100 operations. Cancer 1950;3:972–974.

    Article  PubMed  CAS  Google Scholar 

  11. Graham JC, Pérez FJI. Evisceración pélvica por cáncer Avanzado. Rev Inst Nal Canc 1965;3:125–129.

    Google Scholar 

  12. Lopez MJ, Spratt JS. Exenterative pelvic surgery. J Surg Oncol 1999;72:102–114.

    Article  PubMed  CAS  Google Scholar 

  13. Magrina JF, Stanhope CR, Weaver AL. Pelvic exenterations: supralevator, infralevator, and with vulvectomy. Gynecol Oncol 1997;64:130–135.

    Article  PubMed  CAS  Google Scholar 

  14. Rutledge FN, Smith, JP, Wharton JT, O'Quinn AG. Pelvic exenteration: analysis of 296 patients. Am J Obstet Gynecol 1977;129:881–892.

    PubMed  CAS  Google Scholar 

  15. Lawhead RA, Jr., Clark DG, Smith DH, Pierce VK, Lewis JL, Jr. Pelvic exenteration for recurrent or persistent gynecologic malignancies: a 10-year review of the Memorial Sloan-Kettering Cancer Center experience (1972–1981). Gynecol Oncol 1989;33:279–282.

    Article  PubMed  Google Scholar 

  16. Averette HE, Lichtinger M, Sevin BU, Girtanner RE. Pelvic exenteration: a 15-year experience in a general metropolitan hospital. Am J Obstet Gynecol 1984;150:179–184.

    PubMed  CAS  Google Scholar 

  17. Anthopoulos AP, Manetta A, Larson JE, Podczaski ES, Bartholomew MJ, Mortel R. Pelvic exenteration: a morbidity and mortality analysis of a seven-year experience. Gynecol Oncol 1989;35:219–223.

    Article  PubMed  CAS  Google Scholar 

  18. Soper JT, et al. pelvic exenteration: factors associated with major surgical morbidity. Gynecol Oncol 1989;35:93–98.

    Article  PubMed  CAS  Google Scholar 

  19. Selman AE, Copeland LJ. Surgical management of recurrent cervical cancer. Yonsei Med J 2002;43(6):754–762.

    PubMed  Google Scholar 

  20. Kecmanovic DM, et al. Management of advanced pelvic cancer by exenteration. Eur J Surg Oncol 2003;29:743–746.

    Article  PubMed  CAS  Google Scholar 

  21. Hatch KD, Shingleton HM, Soong SJ, Baker VV, Gelder MS. Anterior pelvic exenteration. Gynecol Oncol 1988;31:205–216.

    Article  PubMed  CAS  Google Scholar 

  22. Hockel M, Baussmann E, Mitze M, Knapstein PG. Are pelvic side-wall recurrences of cervical cancer biologically different from central relapses? Cancer 1994 15;74:648–655.

    Article  Google Scholar 

  23. Goldberg JM, Piver MS, Hempling RE, Aiduk C, Blumenson L, Recio FO. Improvements in pelvic exenteration: factors responsible for reducing morbidity and mortality. Ann Surg Oncol 1998;5:399–406.

    Article  PubMed  CAS  Google Scholar 

  24. Rutledge S, Carey MS, Prichard H, Allen HH, Kocha W, Kirk ME. Conservative surgery for recurrent or persistent carcinoma of the cervix following irradiation: is exenteration always necessary? Gynecol Oncol 1994;52:353–359.

    Article  PubMed  CAS  Google Scholar 

  25. Tarraza HM, Ellerkmann RM. Pelvic radical surgery. Surg Oncol Clin N Am 1998;7(2):399–416.

    PubMed  CAS  Google Scholar 

  26. Leitao MM, Jr, Chi DS. Recurrent cervical cancer. Curr Treat Options Oncol 2002;3:105–111.

    PubMed  Google Scholar 

  27. Pandey D, Zaidi S, Mahajan V, Kannan R. Pelvic exenteration: A perspective from a regional cancer center in India. Indian J Cancer 2004;41:109–114.

    PubMed  Google Scholar 

  28. Leitao MM, Jr, Chi DS. Recurrent cervical cancer. Curr Treat Options Oncol 2002;3:105–111.

    PubMed  Google Scholar 

  29. Lambrou NC, Pearson JM, Averette HE. Pelvic exenteration of gynecologic malignancy: indications, and technical and reconstructive considerations. Surg Oncol Clin N Am 2005;14:289–300.

    Article  PubMed  Google Scholar 

  30. Salom EM, Penalver MA. Pelvic exenteration and reconstruction. Cancer J 2003;9:415–424.

    Article  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Instituto Estatal de Cancerología “Dr. Arturo Beltrán Ortega”, Av. Ruiz Cortines 128, CP 39570, Acapulco Guerrero, México

    M. A. Terán-Porcayo & R. A. C. Gomez del-Castillo

  2. Clinical Research Instituto Nacional de Cancerología México, Ave San Fernando 22, México, D.F., México

    I. Zeichner-Gancz

  3. Surgical Oncology Instituto Nacional de Cancerología, México, Tlalpan 14080, México, D.F., México

    A. Beltrán-Ortega & G. Solorza-Luna

Authors
  1. M. A. Terán-Porcayo
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. I. Zeichner-Gancz
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. R. A. C. Gomez del-Castillo
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. A. Beltrán-Ortega
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. G. Solorza-Luna
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to I. Zeichner-Gancz.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Terán-Porcayo, M.A., Zeichner-Gancz, I., Gomez del-Castillo, R.A.C. et al. Pelvic exenteration for recurrent or persistent cervical cancer. Med Oncol 23, 219–223 (2006). https://doi.org/10.1385/MO:23:2:219

Download citation

  • Received:

  • Accepted:

  • Issue Date:

  • DOI: https://doi.org/10.1385/MO:23:2:219

Key Words

Search

Navigation