Long term outcome and quality of life after pelvic exenteration for recurrent endometrial and cervical cancers
Charlotte Ngô, Christelle Abboud, Paul Meria, Virginie Fourchotte, Pascale Mariani, Bernard Baranger, Xavier Sastre, Caroline Malhaire, Anne-Cécile Philippe, Suzy Scholl, Anne de la Rochefordière, Séverine Alran
Departments of Medical Imaging, Institut Curie Gynaecological Cancer Study Group, Institut Curie, Paris, France.
Departments of Medical Oncology, Institut Curie Gynaecological Cancer Study Group, Institut Curie, Paris, France.
Departments of Pathology, Institut Curie Gynaecological Cancer Study Group, Institut Curie, Paris, France.
Departments of Radiotherapy, Institut Curie Gynaecological Cancer Study Group, Institut Curie, Paris, France.
Departments of Surgical Oncology, Institut Curie Gynaecological Cancer Study Group, Institut Curie, Paris, France.
DOI: 10.4236/ojog.2013.35A1005   PDF   HTML     5,815 Downloads   8,229 Views   Citations


Introduction: Pelvic exenteration can cure recurrent gynecological malignancies. However, treatment morbidity is over 50% in radiated pelves. We evaluated the outcome, the morbidity and the quality of life after 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 logrank 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 treatment. Early complications requiring a re-laparotomy occurred in 9 patients (36%). Late complications included 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 endometrial 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 altered. Endometrial cancer is associated with a poorer prognosis. In those patients, exenteration should be put in balance with best supportive care.

Share and Cite:

Ngô, C. , Abboud, C. , Meria, P. , Fourchotte, V. , Mariani, P. , Baranger, B. , Sastre, X. , Malhaire, C. , Philippe, A. , Scholl, S. , Rochefordière, A. and Alran, S. (2013) Long term outcome and quality of life after pelvic exenteration for recurrent endometrial and cervical cancers. Open Journal of Obstetrics and Gynecology, 3, 19-27. doi: 10.4236/ojog.2013.35A1005.

Conflicts of Interest

The authors declare no conflicts of interest.


[1] Hockel, M. and Dornhofer, N. (2006) Pelvic exenteration for gynaecological tumours: Achievements and unanswered questions. The Lancet Oncology, 7, 837-847. doi:10.1016/S1470-2045(06)70903-2
[2] Perez, C.A., Grigsby, P.W., Nene, S.M., Camel, H.M., Galakatos, A., Kao, M.S. and Lockett, M.A. (1992) Effect of tumor size on the prognosis of carcinoma of the uterine cervix treated with irradiation alone. Cancer, 69, 2796-806. doi:10.1002/1097-0142(19920601)69:11<2796::AID-CNCR2820691127> 3.0.CO;2-O
[3] Resbeut, M., Fondrinier, E., Fervers, B., Haie-Meder, C., Bataillard, A., Lhomme, C., Asselain, B., Basuyau, J.P., Bremond, A., Castaigne, D., Dubois, J.B., Houvenaeghel, G., Lartigau, E., Leblanc, E., Sastre-Garau, X., Sarradet, A., Guastalla, J.P. and Chauvergne, J. (2003) Standards, Options and Recommendations for the management of invasive cervical cancer patients (non metastastic). Bulletin du Cancer, 90, 333-346.
[4] Peiretti, M., Zapardiel, I., Zanagnolo, V., Landoni, F., Morrow, C.P. and Maggioni, A. (2012) Management of recurrent cervical cancer: A review of the literature. Surgical Oncology, 21, e59-e66. doi:10.1016/j.suronc.2011.12.008
[5] Burke, T.W., Heller, P.B., Woodward, J.E., Davidson, S.A., Hoskins, W.J. and Park, R.C. (1990) Treatment failure in endometrial carcinoma. Obstetrics & Gynecology, 75, 96-101.
[6] Berchuck, A., Anspach, C., Evans, A.C., Soper, J.T., Rodriguez, G.C., Dodge, R., Robboy, S. and Clarke-Pearson, D.L. (1995) Postsurgical surveillance of patients with FIGO stage I/II endometrial adenocarcinoma. Gynecologic Oncology, 59, 20-24. doi:10.1006/gyno.1995.1262
[7] Creutzberg, C.L., van Putten, W.L., Koper, P.C., Lybeert, M.L., Jobsen, J.J., Warlam-Rodenhuis, C.C., De Winter, K.A., Lutgens, L.C., van den Bergh, A.C., van der SteenBanasik, E., Beerman, H. and van Lent, M. (2003) Survival after relapse in patients with endometrial cancer: Results from a randomized trial. Gynecologic Oncology, 89, 201-209. doi:10.1016/S0090-8258(03)00126-4
[8] Creutzberg, C.L. (2004) GOG-99: Ending the controversy regarding pelvic radiotherapy for endometrial carcinoma? Gynecologic Oncology, 92, 740-743. doi:10.1016/j.ygyno.2004.01.009
[9] Creutzberg, C.L., van Putten, W.L., Warlam-Rodenhuis, C.C., van den Bergh, A.C., de Winter, K.A., Koper, P.C., Lybeert, M.L., Slot, A., Lutgens, L.C., Stenfert Kroese, M.C., Beerman, H. and van Lent, M. (2004) Outcome of high-risk stage IC, grade 3, compared with stage I endometrial carcinoma patients: The postoperative radiation therapy in endometrial carcinoma trial. Journal of Clinical Oncology, 22, 1234-1241. doi:10.1200/JCO.2004.08.159
[10] Campagnutta, E., Giorda, G., De Piero, G., Sopracordevole, F., Visentin, M.C., Martella, L. and Scarabelli, C. (2004) Surgical treatment of recurrent endometrial carcinoma. Cancer, 100, 89-96. doi:10.1002/cncr.11868
[11] Brunschwig, A. (1948) Complete excision of pelvic viscera for advanced carcinoma; a one-stage abdominoperineal operation with end colostomy and bilateral ureteral implantation into the colon above the colostomy. Cancer, 1, 177-183. doi:10.1002/1097-0142(194807)1:2<177::AID-CNCR2820010203>3.0.CO;2-A
[12] Benn, T., Brooks, R.A., Zhang, Q., Powell, M.A., Thaker, P.H., Mutch, D.G. and Zighelboim, I. (2011) Pelvic exenteration in gynecologic oncology: A single institution study over 20 years. Gynecologic Oncology, 122, 14-18. doi:10.1016/j.ygyno.2011.03.003
[13] Fleisch, M.C., Pantke, P., Beckmann, M.W., Schnuerch, H.G., Ackermann, R., Grimm, M.O., Bender, H.G. and Dall, P. (2007) Predictors for long-term survival after interdisciplinary salvage surgery for advanced or recurrent gynecologic cancers. Journal of Surgical Oncology, 95, 476-484. doi:10.1002/jso.20686
[14] Fotopoulou, C., Neumann, U., Kraetschell, R., Schefold, J.C., Weidemann, H., Lichtenegger, W. and Sehouli, J. (2010) Long-term clinical outcome of pelvic exenteration in patients with advanced gynecological malignancies. Journal of Surgical Oncology, 101, 507-512. doi:10.1002/jso.21518
[15] Maggioni, A., Roviglione, G., Landoni, F., Zanagnolo, V., Peiretti, M., Colombo, N., Bocciolone, L., Biffi, R., Minig, L. and Morrow, C.P. (2009) Pelvic exenteration: Tenyear experience at the European Institute of Oncology in Milan. Gynecologic Oncology, 114, 64-68. doi:10.1016/j.ygyno.2009.03.029
[16] Marnitz, S., Kohler, C., Muller, M., Behrens, K., Hasenbein, K. and Schneider, A. (2006) Indications for primary and secondary exenterations in patients with cervical cancer. Gynecologic Oncology, 103, 1023-1030. doi:10.1016/j.ygyno.2006.06.027
[17] McLean, K.A., Zhang, W., Dunsmoor-Su, R.F., Shah, C.A., Gray, H.J., Swensen, R.E. and Goff, B.A. (2011) Pelvic exenteration in the age of modern chemoradiation. Gynecologic Oncology, 121, 131-134. doi:10.1016/j.ygyno.2010.11.044
[18] Berek, J.S., Howe, C., Lagasse, L.D. and Hacker, N.F. (2005) Pelvic exenteration for recurrent gynecologic malignancy: Survival and morbidity analysis of the 45-year experience at UCLA. Gynecologic Oncology, 99, 153-159. doi:10.1016/j.ygyno.2005.05.034
[19] Jurado, M., Alcazar, J.L. and Martinez-Monge, R. (2010) Resectability rates of previously irradiated recurrent cervical cancer (PIRCC) treated with pelvic exenteration: Is still the clinical involvement of the pelvis wall a real contraindication? A twenty-year experience. Gynecologic Oncology, 116, 38-43. doi:10.1016/j.ygyno.2009.09.035
[20] Sharma, S., Odunsi, K., Driscoll, D. and Lele, S. (2005) Pelvic exenterations for gynecological malignancies: Twenty-year experience at Roswell Park Cancer Institute. International Journal of Gynecological Cancer, 15, 475-482. doi:10.1111/j.1525-1438.2005.15311.x
[21] Pawlik, T.M., Skibber, J.M. and Rodriguez-Bigas, M.A. (2006) Pelvic exenteration for advanced pelvic malignancies. Annals of Surgical Oncology, 13, 612-623. doi:10.1245/ASO.2006.03.082
[22] Soper, J.T., Berchuck, A., Creasman, W.T. and ClarkePearson, D.L. (1989) Pelvic exenteration: Factors associated with major surgical morbidity. Gynecologic Oncology, 35, 93-98. doi:10.1016/0090-8258(89)90020-6
[23] Bladou, F., Houvenaeghel, G., Delpero, J.R. and Guerinel, G. (1995) Incidence and management of major urinary complications after pelvic exenteration for gynecological malignancies. Journal of Surgical Oncology, 58, 91-96. doi:10.1002/jso.2930580204
[24] Moutardier, V., Houvenaeghel, G., Lelong, B., Mokart, D. and Delpero, J.R. (2003) Colorectal function preservation in posterior and total supralevator exenteration for gynecologic malignancies: An 89-patient series. Gynecologic Oncology, 89, 155-159. doi:10.1016/S0090-8258(03)00069-6
[25] Schmidt, A.M., Imesch, P., Fink, D. and Egger, H. (2012) Indications and long-term clinical outcomes in 282 patients with pelvic exenteration for advanced or recurrent cervical cancer. Gynecologic Oncology, 125, 604-609. doi:10.1016/j.ygyno.2012.03.001
[26] Barakat, R.R., Goldman, N.A., Patel, D.A., Venkatraman, E.S. and Curtin, J.P. (1999) Pelvic exenteration for recurrent endometrial cancer. Gynecologic Oncology, 75, 99-102. doi:10.1006/gyno.1999.5536
[27] Morris, M., Alvarez, R.D., Kinney, W.K. and Wilson, T.O. (1996) Treatment of recurrent adenocarcinoma of the endometrium with pelvic exenteration. Gynecologic Oncology, 60, 288-291. doi:10.1006/gyno.1996.0040
[28] Forner, D.M., Lampe, B. (2011) Exenteration as a primary treatment for locally advanced cervical cancer: Long-term results and prognostic factors. American Journal of Obstetrics & Gynecology, 205, 148e1-e6.
[29] Park, S.Y., Bae, D.S., Nam, J.H., Park, C.T., Cho, C.H., Lee, J.M., Lee, M.K., Kim, S.H., Park, S.M. and Yun, Y.H. (2007) Quality of life and sexual problems in disease-free survivors of cervical cancer compared with the general population. Cancer, 110, 2716-2725. doi:10.1002/cncr.23094
[30] Distefano, M., Riccardi, S., Capelli, G., Costantini, B., Petrillo, M., Ricci, C., Scambia, G. and Ferrandina, G. (2008) Quality of life and psychological distress in locally advanced cervical cancer patients administered preoperative chemoradiotherapy. Gynecologic Oncology, 111, 144-150. doi:10.1016/j.ygyno.2008.06.034
[31] Hawighorst-Knapstein, S., Fusshoeller, C., Franz, C., Trautmann, K., Schmidt, M., Pilch, H., Schoenefuss, G., Knapstein, P.G., Koelbl, H., Kelleher, D.K. and Vaupel, P. (2004) The impact of treatment for genital cancer on quality of life and body image—Results of a prospective longitudinal 10-year study. Gynecologic Oncology, 94, 398-403. doi:10.1016/j.ygyno.2004.04.025
[32] Ferrandina, G., Mantegna, G., Petrillo, M., Fuoco, G., Venditti, L., Terzano, S., Moruzzi, C., Lorusso, D., Marcellusi, A. and Scambia, G. (2012) Quality of life and emotional distress in early stage and locally advanced cervical cancer patients: A prospective, longitudinal study. Gynecologic Oncology, 124, 389-394. doi:10.1016/j.ygyno.2011.09.041
[33] Rezk, Y.A., Hurley, K.E., Carter, J., Dao, F., Bochner, B.H., Aubey, J.J., Caceres, A., Einstein, M.H., AbuRustum, N.R., Barakat, R.R., Makker, V. and Chi, D.S. (2013) A prospective study of quality of life in patients undergoing pelvic exenteration: Interim results. Gynecologic Oncology, 128, 191-197. doi:10.1016/j.ygyno.2012.09.030
[34] Roos, E.J., de Graeff, A., van Eijkeren, M.A., Boon, T.A. and Heintz, A.P. (2004) Quality of life after pelvic exenteration. Gynecologic Oncology, 93, 610-614. doi:10.1016/j.ygyno.2004.03.008
[35] Fayers, P.W.S. and Curran, D. (1998) EORTC QLQ-C30. Reference values. European Organisation for Research and Treatment of Cancer.
[36] Magrina, J.F., Stanhope, C.R. and Weaver, A.L. (1997) Pelvic exenterations: Supralevator, infralevator, and with vulvectomy. Gynecologic Oncology, 64, 130-135. doi:10.1006/gyno.1996.4532
[37] Ratliff, C.R., Gershenson, D.M., Morris, M., Burke, T.W., Levenback, C., Schover, L.R., Mitchell, M.F., Atkinson, E.N. and Wharton, J.T. (1996) Sexual adjustment of patients undergoing gracilis myocutaneous flap vaginal reconstruction in conjunction with pelvic exenteration. Cancer, 78, 2229-2235. doi:10.1002/(SICI)1097-0142(19961115)78:10<2229::AID-CNCR27>3.0.CO;2-#
[38] Martinez, A.F.T., Filleron, T., Rouanet, P., Meeus, P., Houvenaeghel, G. and Classe, J.M. Quality of life after exenteration. Gynecologic Oncology, in Press.
[39] Bonvalot, S., de Baere, T., Mendiboure, J., Paci, A., Farace, F., Drouard-Troalen, L., Bonnet, L., Hakime, A., Bonniaud, G., Raynard, B., Israel, P., Le Cesne, A., Eggermont, A.M., Laplanche, A. and Muret, J. (2012) Hyperthermic pelvic perfusion with tumor necrosis factoralpha for locally advanced cancers: Encouraging results of a phase II study. Annals of Surgery, 255, 281-286. doi:10.1097/SLA.0b013e318242ebe7

Copyright © 2023 by authors and Scientific Research Publishing Inc.

Creative Commons License

This work and the related PDF file are licensed under a Creative Commons Attribution 4.0 International License.