Pelvic exenteration as surgical treatment of locoregionally recurrent cervical carcinoma

When a locoregional recurrence of a cervical carcinoma occurs, the last hope from a curative surgical enterprise may be a pelvic exenteration. This procedure remains exceptional. Technically, it combines several standard resections of a number of pelvic organs, such as hysterectomy or colpectomy, partial or total cystectomy, perineectomy, bowel resections, lymphadenectomy.… But its specific application to each of these pelvectomies depends on the optimal process accorded to each particular patient, thereby strongly contrasting with the very codified treatment of initial disease. Using data from a historical series of 30 cases and the material from recent literature, we will try to define the reasonable frontiers to be maintained while undertaking the association of necessarily wide resections along with ambitious functional repairs (such as urinary and digestive continuity, conservation of sphyncteral control, vaginal replacement, filling of large pelvic losses…). The goal is a far from prohibitive 5 year-survival, from 15% globally to 50% in some rigorously selected series. Some mediocre results emphasize the need for evaluation of pejorative criteria, such as age, lateropelvic or upper urinary extensions, lymph node metastasis, or a short delay between initial treatment and relapse. Nevertheless, and however dramatic these conditions may turn out to be, some palliative indications can still be discussed: indeed, the outcome of a well-done exenteration may be considered less intolerable than unavoidable mechanical complications due to the cancerous propagation in itself. When a locoregional recurrence of a cervical carcinoma occurs, the last hope from a curative surgical enterprise may be a pelvic exenteration. This procedure remains exceptional. Technically, it combines several standard resections of a number of pelvic organs, such as hysterectomy or colpectomy, partial or total cystectomy, perineectomy, bowel resections, lymphadenectomy.… But its specific application to each of these pelvectomies depends on the optimal process accorded to each particular patient, thereby strongly contrasting with the very codified treatment of initial disease. Using data from a historical series of 30 cases and the material from recent literature, we will try to define the reasonable frontiers to be maintained while undertaking the association of necessarily wide resections along with ambitious functional repairs (such as urinary and digestive continuity, conservation of sphyncteral control, vaginal replacement, filling of large pelvic losses…). The goal is a far from prohibitive 5 year-survival, from 15% globally to 50% in some rigorously selected series. Some mediocre results emphasize the need for evaluation of pejorative criteria, such as age, lateropelvic or upper urinary extensions, lymph node metastasis, or a short delay between initial treatment and relapse. Nevertheless, and however dramatic these conditions may turn out to be, some palliative indications can still be discussed: indeed, the outcome of a well-done exenteration may be considered less intolerable than unavoidable mechanical complications due to the cancerous propagation in itself.