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. 2021 Nov;163(2):294-298.
doi: 10.1016/j.ygyno.2021.08.033. Epub 2021 Sep 10.

Pelvic exenteration for recurrent or persistent gynecologic malignancies: Clinical and histopathologic factors predicting recurrence and survival in a modern cohort

Alli M Straubhar  1 , Andrew J Chi  1 , Qin C Zhou  2 , Alexia Iasonos  3 , Olga T Filippova  1 , Mario M Leitao Jr  4 , Ibraheem O Awowole  5 , Nadeem R Abu-Rustum  4 , Vance A Broach  4 , Elizabeth L Jewell  4 , Jaspreet S Sandhu  6 , Yukio Sonoda  7
Affiliations

Pelvic exenteration for recurrent or persistent gynecologic malignancies: Clinical and histopathologic factors predicting recurrence and survival in a modern cohort

Alli M Straubhar et al. Gynecol Oncol. 2021 Nov.

Abstract

Objectives: To explore pre-operative factors and their impact on overall survival (OS) in a modern cohort of patients who underwent pelvic exenteration (PE) for gynecologic malignancies.

Methods: A retrospective review was performed for all patients who underwent a PE from 1/1/2010 through 12/31/2018 at our institution. Inclusion criteria were exenteration due to recurrent or progressive carcinoma of the uterus, cervix, vagina or vulva, with histologically confirmed complete surgical resection of the malignancy. Exclusion criteria included PE for palliation of symptoms without recurrence, and for ovarian or rare histologic malignancies. Univariable and multivariable analysis were performed to identify factors predicting prolonged survival.

Results: Overall, 71 patients met the inclusion criteria. Median age at time of exenteration was 62 years (range, 28-86 years). Vulvar cancer was the most common primary diagnosis (32%); 30% had cervical cancer; 23%, uterine cancer; 15%, vaginal cancer. Median OS was 55.1 months (95% confidence interval (CI): 36-not estimable) with a median follow-up time of 40.8 months (95% CI: 1-116.1). On univariable analysis, age > 62 years (hazard ratio (HR) 2.71, 95% CI 1.27-5.79), American Society of Anesthesia (ASA) 3-4 (HR: 3.41 (95% CI 1.03-11.29), and vulvar cancer (HR 4.19 (95% CI 1.17-14.96) predicted worse OS. Tumor size and prior progression-free interval (PFI) did not meet statistical significance in OS analyses. On multivariable analysis, there were no significant factors associated with worse OS.

Conclusions: PE performed with curative intent may be considered a treatment option in well-counseled, carefully selected patients, irrespective of tumor size and PFI before exenteration.

Keywords: Gynecologic malignancy; Pelvic exenteration; Recurrent disease.

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Conflict of interest statement

Conflicts of Interest: None declared.

Figures

Figure 1.
Figure 1.
Overall survival and progression-free survival for the population
Figure 2:
Figure 2:
Sub analysis for OS based upon disease location and histologic type
See this image and copyright information in PMC

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