Surgical treatment for advanced or recurrent disease in cervical cancer

Abstract

In patients with locally recurrent cervical cancer, pelvic exenteration is a viable option with long-term survival in over one third of patients. Depending on the survival disease-free, the site and size of recurrence can be set 5-year survivals of 48-60%. Since it was first reported in 1948, pelvic exenteration has been used in the treatment of advanced pelvic cancers. The original procedure has been modified in an attempt to preserve urinary or fecal continence. The subclassification of the exenteration groups into type I (supralevator), type II (infralevator), and type III (with vulvectomy) is helpful to facilitate understanding of the extent of resection of the pelvic structures and the anatomical changes associated with each operation. Pelvic exenteration should only be undertaken by experienced surgeons at specialized centers. Restorative techniques for both urinary and gastrointestinal tracts can diminish the need for stomas and, along with vaginal reconstruction, can significantly improve quality of life for many patients afterexenteration. These advances in surgery and radiotherapy help make the procedure a viable option for patients with otherwise incurable elvic malignancy.