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Palliative Total Pelvic Exenteration for Gynecologic Cancers: A Cross-sectional Study of Society of Gynecologic Oncology Members
  1. Shannon MacLaughlan David, MD*,
  2. Nicole Marjon, MD, PhD*,
  3. Diana English, MD*,
  4. Natasha Purington, MS,
  5. Summer S. Han, PhD and
  6. Don S. Dizon, MD
  1. *Department of Obstetrics and Gynecology, Stanford University School of Medicine, Stanford, CA;
  2. Quantitative Science Unit, Stanford University School of Medicine, Stanford, CA;
  3. Lifespan Cancer Institute, Warren Alpert Medical School of Brown University, Providence, RI.
  1. Address correspondence and reprint requests to Shannon MacLaughlan David, MD. E-mail: Smacdavid76{at}


Objective The aim of this study was to evaluate contemporary practices and opinions among gynecologic oncologists regarding the use of total pelvic exenteration (TPE) for palliative intent.

Methods This cross-sectional study of the membership of the Society of Gynecologic Oncology utilized an electronic survey to assess the opinions and practice patterns of gynecologic oncologists regarding TPEs. The primary outcome was willingness to consider a TPE for palliative intent, and demographic and practice characteristics were collected for correlation. Qualitative data were also collected. Descriptive statistics are presented, and χ2 tests, Fisher exact tests, and logistic regression analyses were used.

Results We included 315 surveys for analysis, for a completed response rate of 23.5%. Approximately half (52.4%, n = 165) of respondents indicated willingness to consider palliative TPE. When controlled for all variables, gynecologic oncologists who were more than 10 years out of fellowship were less likely to perform a palliative exenteration (odds ratio, 0.55; 95% confidence interval, 0.30–0.98), whereas those who reported experience with minimally invasive exenteration were more likely to offer it for palliation (odds ratio, 2.20; 95% confidence interval, 1.07–4.73). Fifty-three respondents (16.8%) provided qualitative data. The themes that emerged as considerations for TPE as palliation were (1) symptoms and quality of life, (2) surgical and perioperative morbidity, (3) anticipated overall survival, (4) counseling and informed consent, (5) functional status and comorbidities, (6) likelihood of residual disease, and (7) alternative procedures available for palliation.

Conclusion Half of gynecologic oncologists seem to be willing to offer a palliative TPE, although more-experienced gynecologic oncologists are more likely to reserve the procedure for curative intent.

  • Cervical cancer
  • Surgery
  • Uterine cancer
  • Vaginal cancer
  • Vulvar cancer

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  • This study received research information technology grant support (Stanford Clinical and Translational Science award no. UL1TR001085 from NIH/NCRR) for the use of Research Electronic Data Capture (REDCap) tools.

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