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Pelvic Exenteration for Recurrent Gynecologic Malignancy: A Study of 28 Consecutive Patients at a Single Institution
  1. Linda Jäger, MD*,
  2. Per J. Nilsson, MD, PhD and
  3. Angelique Flöter Rådestad, MD, PhD*
  1. *Division of Obstetrics and Gynecology, Department of Women’s and Children’s Health, and
  2. Division of Coloproctology, Center of Surgical Gastroenterology, Karolinska University Hospital, Stockholm, Sweden.
  1. Address correspondence and reprint requests to Linda Jäger, MD, Division of Obstetrics and Gynecology, Department of Women’s and Children’s Health, Karolinska University Hospital, 171 76 Stockholm, Sweden. E-mail:


Objective The aim of this study was to assess the outcomes of patients undergoing pelvic exenteration (PE) for recurrent gynecologic malignancy.

Methods A retrospective review using all medical records of 28 consecutive patients who underwent PE between January 2002 and December 2011 at a single institution was conducted. Complications were graded according to Clavien-Dindo. Overall survival (OS) and disease-free survival (DFS) were estimated by the method of Kaplan-Meier.

Results Pelvic exenteration was performed for recurrent cancer in all patients. Distribution of primaries was as follows: cervix (n = 10), vagina (n = 5), ovary (n = 5), uterus (n = 4), tube (n = 2), Bartholin gland (n = 1), and vulva (n = 1). In all but 1 case, PE was performed with curative intent. Pelvic exenteration was total (n = 11), anterior (n = 2), or posterior (n = 15). Reconstructive procedures included urinary tract (n = 13), gastrointestinal tract (n = 26), pelvic floor (n = 6), and vagina (n = 5). There was no postoperative mortality within 30 days. All patients developed 1 or several early complications of various grades, and 22 patients (79%) developed late complications. Twelve patients (43%) underwent reoperation because of complications to PE, and 2 patients died within follow-up as a consequence of their PE. A complete tumor resection (R0) was obtained in 23 patients (82%). With a median follow-up of 27 months (range, 2–110 months), the 5-year OS and DFS rates were 70% and 41%, respectively. R0 resection was associated with increased OS (P < 0.001) and DFS (P = 0.015).

Conclusions Pelvic exenteration for recurrent gynecologic malignancies can be associated with long-term survival in selected patients. However, postoperative complications are common and can be lethal.

  • Pelvic exenteration
  • Recurrent gynecologic malignancy
  • Surgery
  • Complications
  • Survival

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  • Sources of support and funding: none. The authors declare no conflicts of interest.

  • Senior author: Angelique Flöter Rådestad.