Pelvic exenteration for gynecologic malignancies: The experience of a tertiary center from Greece

Pelvic exenteration is an ultraradical procedure that is performed for locally advanced pelvic malignancies. Despite its rarity, the rates of the procedure increase during the last years due to the gain of surgical expertise. Data on survival rates remain; however, scarce in the literature.

We retrospectively reviewed the records of all patients who underwent exenterative procedures for advanced gynecologic malignancies between 2006 and 2020. Major and minor perioperative complications were documented according to the Clavien-Dindo classification only when they occurred during a time limit of 30 days from the operation. Cox regression analysis and Kaplan-Meier survival curves were used for the analysis of survival outcomes.

Overall, we identified 138 patients who were offered a pelvic exenteration procedure that were followed up for a median of 42 months (range 6-60 months). Seventy-five patients recurred (54.3%) during the follow-up period within 35.04 months (95% CI 31.01, 39.07 months). After examining several potential factors that might influence survival rates, we observed that only patients with positive margins had increased risk of recurrence (HR 1.66, 95%CI 1.10, 2.56 p = .016), although this was not associated with a decrease in overall survival. Overall survival outcomes were available for 112 patients of whom 62 died (55.4%) within 38.84 months (95% CI 35.02, 42.67). Major complications were detected in 21 patients. Reoperation was required in 18 patients. Anastomotic leakage was observed in 7 cases (5%) of whom 4 patients required reoperation.

In summary, the findings of our study suggest that women undergoing pelvic exenteration for gynecologic malignancies have a significant survival probability that is accompanied by acceptable rates of operative morbidity.