Operative laparoscopy prior to a pelvic exenteration in patients with recurrent cervical cancer

Selecting out the true candidates for a pelvic exenteration frequently poses a difficult clinical dilemma in patients with recurrent cervical cancer after radiation therapy. Despite very thorough preoperative investigation, inoperable disease is discovered at the time of laparotomy in up to 60% of cases.

In this retrospective analysis, we report the use of operative laparoscopy in 13 patients with either biopsy proven locally recurrent cervical cancer (N = 9) or with clinically suspected tumor recurrence (N = 4). All have previously received radical radiation therapy.

Patients' ages ranged from 36 to 79 years (median, 43). The median duration of the procedure was 150 min (range,50-200) and median blood loss was 50 cc (range, 50-200). The procedure was well tolerated in all patients. There was no intraoperative complication. One deep thrombophlebitis occurred postoperatively. The laparoscopic evaluation could not be completed in one case because of a large nonmobile uterine fibroid filling the whole pelvis. At laparoscopy, metastatic tumor was identified in 9 of 12 patients (75%). An unnecessary laparotomy was avoided in 8 of those 9 cases (one had a palliative exenteration). The most common site of metastasis was in the previously radiated pelvis (7/9). Three patients had a negative laparoscopy. Two had an exenteration and one had a transureteroureterostomy. At the time of laparotomy, none were found to have disease that would have been missed at laparoscopy.

We conclude that operative laparoscopy may be a valuable additional step in the work-up and management of patients with locally recurrent cervical cancer. With experience in retroperitoneal surgery, the procedure can be carried out safely in previously radiated patients. We believe this approach can lower the number of unnecessary laparotomies, reduce the morbidity, and shorten the length of the postoperative recovery.