Pelvic Exenterations for Advanced and Recurrent Endometrial Cancer: Clinical Outcomes of 40 Patients.

OBJECTIVE: The aim of this study was to analyze the clinical experience and outcome of patients who have undergone pelvic exenteration for primary advanced or recurrent endometrial cancer. METHODS: We analyzed the medical records of 40 women who underwent pelvic exenteration to treat primary advanced or recurrent endometrial cancer. RESULTS: Pelvic exenteration was performed in 40 patients with primary advanced or recurrent endometrial cancer. Three patients (8%) underwent a primary exenteration, and 37 patients (92%) underwent a secondary exenteration. A total exenteration, anterior exenteration, and posterior exenteration was performed in 85%, 5%, and 10% of patients, respectively.In 31 cases, exenteration was performed with a curative aim, and in 9 cases, exenteration was performed with a palliative aim. The overall survival rates were 61.4% at 5 years and 51.1% at 10 years. For the 31 patients who underwent pelvic exenteration with a curative aim, the overall survival rates were higher than those for the entire study population and were 72.6% at 5 years and 59.4% at 10 years. For the 9 patients who underwent a palliative exenteration, the overall survival rates were 19.1% at 5 years and 0% at 10 years. This is to the best of our knowledge the biggest study of pelvic exenteration in patients with endometrial cancer. CONCLUSIONS: Our data show that pelvic exenterations are a valid therapeutic option with long-term survival in select patients.

Surgical technique of a recurrent post-radiation vesicovaginal fistula with a small intestine graft.

Vesicovaginal fistulas are devastating conditions for the affected women. The combination of a hysterectomy and radiation increases the fistula risk 5-10 times. Radiation-induced recurrent vesicovaginal fistulas have the lowest success rate and require the most demanding treatment. We present the case of a recurrent post-radiation vesicovaginal fistula treated with a small intestine graft after unsuccessful conservative and failed previous operative treatments. The surgical management with a small intestine graft led to a permanently closed fistula. We describe the surgical abdominal procedure step-wise and review the rather scarce, post-radiation fistula literature. The closure of a vesicovaginal fistula with a small intestine graft is a complex surgical treatment with a long-term, successful result.

Multivisceral cytoreductive surgery in FIGO stages IIIC and IV epithelial ovarian cancer: results and 5-year follow-up.

OBJECTIVE: The present study reviews our 5-year results with extensive, multivisceral cytoreduction in patients with FIGO stages IIIC and IV ovarian cancer. METHODS: During the five-year period from January 1995 to December 1999, 101 patients with primary epithelial ovarian cancer FIGO stages IIIC and IV had extensive multivisceral cytoreductive surgery at our department. Patients' history, surgery data, staging, recurrence and survival data were abstracted from the patients' records. RESULTS: Eighty-four (83%) patients had no gross residual disease after the complete surgical procedure. Mean follow-up was 46 months (range, 1-130). Eight patients died within 6 months postoperatively. Seventy-six of our one hundred one patients (75%) had disease progression or recurrence after a mean of 28 months (range, 4-110). Seventeen (17%) patients are alive without disease. Median survival was 47 months and five-year survival was 33% for all 101 patients. CONCLUSION: This series indicates that in the majority of patients with advanced ovarian cancer, primary surgery can lead to complete gross cytoreduction with substantial subsequent rates of disease-free and overall survival.