Pelvic Exenteration for Advanced and Recurrent Gynecologic Malignancies: Surgical Morbidity and Survival Outcomes...

Introduction Pelvic exenteration (PE) involves en-bloc removal of central pelvic organs and is indicated for patients with locally advanced or recurrent cervical, endometrial, ovarian, vaginal, and vulvar cancers. Our study aimed to analyze the surgical morbidity and survival in patients who underwent pelvic exenteration surgery for gynecological malignancies. Methods Sixty patients underwent pelvic exenteration for gynecological malignancy at our centre from January 2013 to December 2020. We included all patients who underwent a pelvic exenteration procedure for locally advanced or recurrent cervical, ovarian, endometrial, vaginal and vulvar cancers with both curative and palliative intent. The primary objective was to analyze the perioperative complications, pattern and severity of perioperative morbidity, and the requirement for reconstruction procedures. The secondary objective was to analyze the disease-free survival (DFS) and overall survival (OS) associated with this radical procedure Results Among 60 patients who underwent the exenteration procedure, total, anterior, and posterior exenteration was performed in two (3.33%), two (3.33%), and 56 (93.33%) patients, respectively. Intraoperative complications occurred in 13 cases. Median follow-up period was 50 months. The OS rates were 87.7% at one year, 78.5% at two years, 58% at three years, and 36.6% at four years and DFS showed a similar declining trend over time, with 75.1% of patients remaining disease-free at one year, 50.0% at two years, 28.0% at three years, and 25.7% at four years. Conclusion In summary, pelvic exenteration is a definite option in indicated cases of advanced gynecological malignancies in the background of advanced surgical techniques, modern intensive care facilities, and surgical expertise. With respect to survival benefits, exenteration procedures are associated with an acceptable rate of major complications.