Extended pelvic resections for recurrent uterine and cervical cancer: Out-of-the-box surgery Journal Article


Authors: Caceres, A.; Mourton, S. M.; Bochner, B. H.; Gerst, S. R.; Liu, L.; Alektiar, K. M.; Kardos, S. V.; Barakat, R. R.; Boland, P. J.; Chi, D. S.
Article Title: Extended pelvic resections for recurrent uterine and cervical cancer: Out-of-the-box surgery
Abstract: Patients with recurrent uterine and cervical cancer have poor prognoses. The objective of this study was to analyze the outcomes of patients with recurrent uterine and cervical cancer who had undergone attempted curative resection of pelvic bone, sidewall muscle, major blood vessels, and/or nerves. We reviewed the records of all 14 patients with recurrent uterine and cervical cancer who had extended pelvic resections at our institution between June 2000 and November 2006. Primary sites of disease were the uterus (11 patients) and cervix (3 patients). Tumor histology was as follows: adenocarcinoma, seven; squamous cell carcinoma, three; leiomyosarcoma, three; and adenosarcoma, one. Previous treatment included hysterectomy, 11; pelvic radiation, 9; chemotherapy, 9; and total pelvic exenteration, 2. Extended pelvic resections included removal of pelvic sidewall muscle, five; bone, five; common and/or external iliac vessel, five; femoral nerve, two; lumbosacral nerve root, one; and obturator nerve, one. Other procedures included total pelvic exenteration, three; posterior exenteration, two; and anterior exenteration, one. Complete resection with negative margins was obtained in 11 (78%) of 14 patients. Seven patients (50%) received high-dose rate intraoperative radiation therapy. Reconstructive procedures included continent or incontinent urinary diversion, four; femoral-femoral arterial bypass, two; myocutaneous flap, two; and urinary ileal interposition, one. Median total operating time was 628 min (range, 345-935 min) and median estimated blood loss was 900 mL (range, 300-16,000 mL). Seven patients (50%) had one or more major complication(s), including pelvic abscess, three; colonic fistula, two; massive intraoperative hemorrhage, one; postoperative bladder perforation, one; thrombosed femoral-femoral graft, one; and disruption of appendicocutaneous urinary anastomosis, one. At a median follow-up of 26 months (range, 5-84 months), ten patients (71%) are alive and four patients (29%) have died of disease at 8, 13, 33, and 42 months postoperatively. © 2007, Copyright the Authors.
Keywords: adult; cancer chemotherapy; clinical article; controlled study; aged; middle aged; cancer radiotherapy; follow up; magnetic resonance imaging; hysterectomy; neoplasm recurrence, local; bleeding; antiinfective agent; uterine cervix cancer; pelvis exenteration; uterus cancer; uterine cervical neoplasms; uterine cancer; pelvic exenteration; extended pelvic resection; out-of-the-box surgery; recurrent cervix cancer
Journal Title: International Journal of Gynecological Cancer
Volume: 18
Issue: 5
ISSN: 1048-891X
Publisher: Lippincott Williams & Wilkins  
Date Published: 2008-09-01
Start Page: 1139
End Page: 1144
Language: English
DOI: 10.1111/j.1525-1438.2007.01140.x
PUBMED: 18053063
PROVIDER: scopus
DOI/URL:
Notes: --- - "Cited By (since 1996): 8" - "Export Date: 17 November 2011" - "CODEN: IJGCE" - "Source: Scopus"
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MSK Authors
  1. Richard R Barakat
    629 Barakat
  2. Patrick J Boland
    160 Boland
  3. Dennis S Chi
    707 Chi
  4. Kaled M Alektiar
    333 Alektiar
  5. Laibin Liu
    1 Liu
  6. Scott R Gerst
    48 Gerst
  7. Bernard Bochner
    468 Bochner
  8. Lisa Liu
    2 Liu