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Surgeon’s Corner
Prognostic Factors for Curative Pelvic Exenterations in Patients With Recurrent Uterine Cervical or Vaginal Cancer
  1. Hugo Sardain, MD*,†,
  2. Vincent Lavoué, MD, PhD*,†,‡,
  3. Bruno Laviolle, MD, PhD‡,§∥,,
  4. Sébastien Henno, MD#,
  5. Fabrice Foucher, MD* and
  6. Jean Levêque, MD, PhD*,†,‡
  1. *Gynecology Department, Tertiary Surgery Center, Teaching Hospital of Rennes;
  2. †Faculty of Medicine, Rennes University;
  3. ‡Team Death Receptors and Tumor Escape, Inserm U1085;
  4. §Inserm, CIC-P0203 Clinical Investigation Centre;
  5. ∥Experimental and Clinical Pharmacology Laboratory, University of Rennes 1; and
  6. Department of Clinical Pharmacology and
  7. #Pathology Department, Teaching Hospital of Rennes, Rennes, France.
  1. Address correspondence and reprint requests to Vincent Lavoué, MD, PhD, Gynecology Department, Tertiary Surgery Center, Teaching Hospital of Rennes, Hôpital Sud, 16, Bd de Bulgarie, 35000 Rennes, France. E-mail: vincent.lavoue@chu-rennes.fr.

Abstract

Objectives The aim of this study was to assess the prognostic factors after curative pelvic exenterations performed for recurrent uterine cervical or vaginal cancers in the era of concomitant chemoradiotherapy.

Methods We retrospectively enrolled 16 patients with recurrent uterine cervical or vaginal cancer and tumor-free resection margins on pelvic exenteration pathological analysis between October 1997 and April 2014.

Results Pelvic exenterations were performed for 13 recurrent cervical cancers and 3 recurrent vaginal cancers. All of the patients had received pelvic irradiation (external radiotherapy for 14 patients and brachytherapy for 2 patients). The median age at the recurrence was 59.5 years (49–77 years), and the median tumor size was 4.35 cm (2–9 cm). There were no intraoperative or postoperative deaths. The 5-year disease-free survival and overall survival were 30% and 34.1%, respectively. The following 3 factors affected the disease-free survival: tumor size greater than 5 cm (P = 0.05), mesorectal lymph node involvement (P = 0.02), and vascular emboli (P = 0.0093).

Conclusions The presence of vascular emboli is a new prognostic factor in cases of recurrent cervical or vaginal cancer. Assessing the presence of vascular emboli on pretherapeutic biopsies could facilitate the selection of patients eligible for curative pelvic exenterations.

  • Pelvic exenteration
  • Recurrent cervical or vaginal cancer
  • Vascular emboli
  • Prognostic factors

https://doi.org/10.1097/IGC.0000000000000288

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    Footnotes

    • The authors declare no conflicts of interest.