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Modified Posterior Pelvic Exenteration for Ovarian Cancer
  1. Gilles Houvenaeghel*,
  2. Martin Gutowski,
  3. Max Buttarelli*,
  4. Jean Cuisenier,
  5. Fabrice Narducci§,
  6. Christian Dalle,
  7. Gwenael Ferron,
  8. Phillippe Morice**,
  9. Pierre Meeus††,
  10. Eberhart Stockle††,
  11. Marie Bannier*,
  12. Eric Lambaudie*,
  13. Phillippe Rouanet,
  14. Jean Fraisse,
  15. Eric Leblanc§,
  16. Jacques Dauplat,
  17. Denis Querleu,
  18. Pierre Martel and
  19. Damien Castaigne**
  1. *Service de Chirurgie Oncologique 2, Institut Paoli-Calmettes, Marseille;
  2. Service de Chirurgie Générale Oncologique, Parc Euromédecine, Centre Val d'Aurelle, Montpellier;
  3. Service de Chirurgie Oncologique, Centre Georges-François Leclerc, Dijon;
  4. §Service de Chirurgie Oncologique, Centre Jean Perrin, Clermont Ferrand;
  5. Service de Chirurgie Oncologique, Centre Claudius Regaud, Toulouse;
  6. Service de Chirurgie Oncologique, Institut Gustave Roussy, Villejuif;
  7. **Service de Chirurgie Oncologique, Centre L Berard, Lyon; and
  8. ††Service de Chirurgie Oncologique, Institut Bergonieé, Bordeaux, France.
  1. Address correspondence and reprint requests to Gilles Houvenaeghel, Service de Chirurgie Oncologique 2, Institut Paoli-Calmettes, 232 Boulevard de Sainte Marguerite, 13273 Marseille Cedex, France. E-mail: houvenag{at}marseille.fnclcc.fr.

Abstract

Introduction: A modified posterior pelvic exenteration (MPE) might be needed to reach an optimal tumoral reduction. The issue of this study is to relate a multicentric experience of this kind of resection.

Materials: Three hundred five patients who needed an MPE were analyzed from 9 French cancer centers. One hundred sixty-eight MPEs were performed during initial surgery (55.1%), 69 during interval surgery (22.6%), 36 after chemotherapy (11.8%), and 32 for recurrences (10.5%).

Results: Three hundred two colorectal anastomoses were realized with a protective stoma in 59 (19.5%) of cases and a stoma closure in 76.5% (51). The rate of functional anastomosis was 96% (290/302). Complications occurred in 26.9% (82/305) of the patients, with a fistula in 25 (8.2%). The reintervention rate was 8.8% (27/305). The median length of hospitalization was 15 days. The absence of a macroscopic residual disease was obtained in 58% (173/303) of cases. A residual disease that was 1 cm or smaller was observed in 73 cases (24%) and 2 cm or smaller observed in 36 (11.9%). Postoperative chemotherapy was started with a median time of 32 days.

Postoperative death occurred in 1 patient (0.33%). The survival rates were 62.7% and 27.6% at 2 and 5 years, respectively. With a multivariate analysis, the 2 significant prognostic factors were residual disease and time of surgery (P < 0.0001).

Conclusions: A rectal invasion should not be an obstacle to reach the aim to obtain a macroscopic minimal residual disease or, if possible, the absence of one. An MPE is useful in those cases to reach optimal cytoreduction, with comparable results whatever the patient's age is. A temporary protective stoma should be considered only exceptionally.

  • Ovarian cancer
  • Pelvic exenteration

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Footnotes

  • Groupe des Chirurgiens de la Fédération des Centres de lutte contre le cancer (GCFC).

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