Pelvic exenterative therapy for gynecologic malignancy: an analysis of 70 cases

During the 10-year period from June 1, 1965 to June 1, 1975 70 patients with gynecologic malignancy were treated with some type of pelvic exenteration at the University of Michigan Medical Center. Total pelvic exenteration was performed in over 75% of the cases. The most recent figures suggest a 3-year and 5-year survival rate of over 60%. The surgical mortality is 1.4%: the hospital mortality is 1.4%. Those patients with squamous cell disease, such as recurrent carcinoma of the cervix, vagina or vulva, have a better prognosis than do those patients with gland cell disease. Regional lymph node involvement gives a bad prognosis. Advances in therapeutic techniques during this 10-year period, including: 1) use of prophylactic antibiotics: 2) transverse abdominal incision; 3) so-called "ski-position" on the operating table; 4) prophylactic compartmentalization of the inferior vena cava; 5) uretero-sigmoid conduit for urinary diversion; 6) peritoneal graft as a "lid" over the pelvic vault' and 7) split-thickness skin graft vaginoplasty as part of the rehabilitation program, are discussed.