Survival after curative pelvic exenteration for primary or recurrent cervical cancer: a retrospective multicentric study of 167 patients

Abstract

Objective: Evaluate the survival of patients who underwent pelvic exenteration (PE) with curative intent for primary persistent or recurrent cervical cancer.

Methods: We retrospectively investigated 167 consecutive patients, referred to the gynecological oncology units of 4 centers in Germany or Italy, who underwent PE. Data regarding surgery, histology, and oncologic outcomes were collected and statistically evaluated. Survival was determined from the day of exenteration until last follow-up or death.

Results: The median age was 51 years. Twenty-seven patients (16.2%) underwent PE owing to advanced primary tumors (group A), 34 patients (20.4%) underwent PE owing to persistent cancer after chemotherapy or chemoradiation (group B), and 106 patients (63.4%) underwent PE owing to recurrence (group C). The prevalent histologic type was squamous cell cancer. A complete tumor resection (R0), was achieved in 121 patients (72.5%). Forty-nine patients (29.3%) had pelvic lymph node metastases and 44 patients (26.3%) had pelvic sidewall involvement. Overall survival at the end of the study was 40.7%. The cumulative 5-year overall survival for the entire cohort was 38%. Resection margins, pelvic lymph node state, and sidewall involvement were independent prognostic factors in multivariate analysis.

Conclusion: Pelvic exenteration is a valid therapeutic option for patients with locally advanced primary persistent or recurrent cervical cancer, with a long-term survival in 40% of the patients.