623 Pelvic exenteration for locally advanced and relapsed gynecologic cancer: morbidity and long-term survival

Introduction/Background*

Pelvic exenteration (PE) can be described as the most radical surgery performed in patients with recurrence or persistence of gynecologic cancer. The aim of this study was to evaluate morbidity and survival after PE. Furthermore we analyzed the impact of type of PE and age on survival.

Methodology

This is a retrospective observational study including patients with histological diagnosis of gynecologic malignant pelvic tumor (cervix, ovary, endometrium, vulva, vagina, and sarcoma), who underwent PE with curative intention at our institution between 1999 and 2021. Overall survival (OS) was assessed with Kaplan-Meier analysis. Differences in survival according to type of PE (anterior, posterior or total) were assessed using log-rank tests. Multivariate analysis using Cox-proportional hazard models was performed to determine the impact of age on survival outcomes. Results were considered statistically significant when p<0,05.

Result(s)*

In total, 56 patients were included in the study. Average age at the time of surgery was 58,3 (SD 14,4) years. Distribution of tumor site was: ovary (n=32), cervix (n=10), endometrium (n=8), vulva/vagina (n=6). PE was anterior (n=6), posterior (n=31) or total (n=19). One case of intraoperative complication was observed, with a vascular lesion that was sutured with no further aggravation. Overall, morbidity occurred in 46,4% of patients; 18 (32,1%) developed early complications and 8 (14,3%) developed at least one late complication, including 7 gastrointestinal, 3 urinary, 4 incision hernias and 11 infectious complications. Fourteen cases required reintervention due to complications. Only one case of early postoperative death was recorded. The 5-year OS in remaining cases was 31%. Median follow-up time was 22,5 months (range: 1-242). Mean overall survival tended to be longer for patients with anterior PE (150,6 months, SD 49,5) than for patients with posterior PE (51,0 months, SD 11,3) or total PE (41,2 months, SD 14,3), although this difference was not statistically significant (p=0,113). The 5-year OS was 60%, 25% and 25%, respectively. Age had no impact on survival.

Conclusion*

PE is still the only curative option for selected patients, when chemoradiation and/or primary surgery failed in recurrent or persistent gynecological malignancies. When performed by expert gynecologic-oncology surgeons, this intervention has an acceptable survival and perioperative morbidity rate.