Role of Pelvic Exenteration in the Treatment of Persistent or Recurrent Gynecological Cancers

Abstract

Objective: To assess the oncological outcomes of Persistent/Recurrent Gynaecological Cancers who underwent Pelvic Exenteration (PE) in terms of DFS and OS in a 23 years-single center experience. Secondary outcome was to identify factors associated with recurrence. Methods: From June 1996 to March 2019, data of all patients who underwent PE were retrospectively collected. The Kaplan-Meier method was used to estimate DFS and OS. Univariable and multivariable logistic regression analysis was performed to identify potential independently associated predictors of recurrence. Results: 192 patients were considered for final analysis. After surgery 77 women (40.1%) received a post-operative oncologic treatment. Overall 106 patients (55.2%) experienced a relapse with a median follow-up of 58 months (range, 2 to 236 months). Presence of LVI (adjusted HR 2.2, 95% CI 1-4.9, P=0.05) was the only factor that retained an independent association with relapse at multivariable analysis. Positive lymph nodes were associated with death at univariable analysis (HR 3.9, 95% CI 1.7-9.4, P=0.002). When stratifying patients by cervical cancer, among 115 women, 67 (58.3%) relapsed. Presence of LVI (HR 2.7, 95% CI 1.1-6.6, P=0.02) and patients with pathologic risk factors such as tumor size, positive lymph nodes and LVI (HR 3.1, 95% CI 1.4-6.8, P=0.005) were associated with recurrence both at univariable and multivariable analysis. Conclusion: Pelvic exenteration may have a therapeutic role in cervical and endometrial tumors that recur at least 6 months after primary treatment. Patients affected by vulvar cancer or either with tumor size >5 cm, positive lymph nodes, LVI have worse oncologic outcomes.