Long term outcome and quality of life after pelvic exenteration for recurrent endometrial and cervical cancers

Abstract

Introduction: Pelvic exenteration can cure recurrent gynecological malignancies. However, treatment mor-bidity is over 50% in radiated pelves. We evaluated the outcome, the morbidity and the quality of life af-ter exenteration. Methods: Patients who underwent an exenteration for recurrent cervical or endometrial cancer in our institution between 1999 and 2011 were retrieved. Survival rates were calculated according to Kaplan-Meier method and compared using the log-rank test. The EORTC QLQ-C30 and QLQ-CX24 questionnaires were sent to patients alive in January 2012. Results: We identified 25 patients: 17 (68%) had cervical cancer and 8 (32%) endometrial cancer. 92% of them had received radiotherapy previously. All patients had a central pelvic recurrence, within a median time of 30 months [4 -384] from initial treat-ment. Early complications requiring a re-laparotomy occurred in 9 patients (36%). Late complications in-cluded 2 (8%) fistulas, 2 (8%) occlusion and 1 (4%) ureteral stenosis. Complete resection was obtained in 92% of patients. Disease Free and Overall survival rates were better in cervical rather than in endome-trial cancer (median DFS in months 17 [2 -145] vs 9.5 [3 -21], p = 0.064, median OS in months 20 [2 -145] vs 13 [4 -42], p = 0.019). 69% of patients answered the quality of life questionnaires. Mean global quality of life score was 45 on a scale of 0 -100, none of the patients had a sexual activity. Conclusions: Morbidity of exenteration remains high and quality of life is al-tered. Endometrial cancer is associated with a poorer prognosis. In those patients, exenteration should be put in balance with best supportive care.