Pelvic Exenteration for Primary Advanced and Recurrent Vaginal Cancer: Clinical Outcome for 37 Patients

Objective: To analyze the clinical outcome of patients after pelvic exenteration for advanced primary or recurrent vaginal cancer. Design: Retrospective cohort study. Materials and Methods: We analyzed the outcome of 37 patients after pelvic exenteration for advanced primary or recurrent vaginal cancer. Results: The most common histologic type was the squamous cell carcinoma (78%). In total 86% of cases were stage III/IV carcinomas with a cancer grade of 3 in 65% of cases. Totally, 46% of cases were primary, 54% were secondary exenterations. We performed a total exenteration in 72%, an anterior or posterior in 14% each. A total of 76% of exenterations had a curative intention. R0 resection was achieved in 86% of cases. No major peri- or postoperative complications were found in 46% of patients. Death occurred in three patients (8%), all of them elderly and with comorbidities. Five- and 10-year overall survival rates ranged from 45.3% to even 88.9% in the best subgroup. Survival rates strongly depended on the type and intention of exenteration. The best survival rates were found in younger women with a primary exenteration in a curative intent and with metastasis-free lymph nodes. Conclusion: Pelvic exenteration is a valid treatment option in advanced or recurrent vaginal cancer with low procedural mortality and good long-term survival rates in selected patients. Even in a palliative setting, 12.6% of patients survived long term. However, complication rates are still high and need to be intensively discussed with patients. In addition, long-term follow-up and attendance are strongly recommended to support patients in such a situation.