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#548 Is still there a place for primary pelvic exenterations, mainly in patients with fistulas?
  1. Mihai Emil Capilna1,
  2. Tudor Emil Capilna2,
  3. Dan Mihai Capilna3 and
  4. Mihai Gheorghe4
  1. 1First Obstetrics and Gynecology Clinic, Targu Mures, Romania
  2. 2‘G. E. Palade’ University of Medicine, Targu Mures, Romania
  3. 3Pharmacy, Targu Mures, Romania
  4. 4Science and Technology, Targu Mures, Romania


Introduction/Background A pelvic exenterative procedure could be performed for advanced gynecologic, urologic or rectal cancers in selected patients as a primary treatment with curative intent, mainly when a recto- or a vesico-vaginal fistula is present.

Methodology A retrospective study was performed in 27 patients submitted to primary pelvic exenterations in a tertiary university hospital between 2011 and 2022.

Abstract #548 Figure 1

Total infralevatorian exenteration with vulvectomy

Results The patients’ mean age was 54.7 years old. The oncological indications for surgery were as follow: stage IVa cervix cancer (13 cases, 48.1%), stage IVa cancer of the vagina (7 cases, 25.9%), stage IVa endometrial cancer (1 case, 3.7%), stage IVa urinary bladder cancer (4 cases, 14.8%), stage IVb rectal cancer (1 case) and undifferentiated pelvic sarcoma (1 case). An anterior, total and, respectively, posterior pelvic exenterations were performed in 11, 11 and 5 of the patients. In respect to levator ani muscle, 14 procedures were supralevatorian, 12 infralevatorian, and 5 were infralevatorian with vulvectomy. No major intraoperative complications have occured. In 8 patients (30.7%), early complications were recorded and in 5 (17.4%) a reoperation was required. In our series, two perioperative deaths caused by cardio-vascular and not because of surgical complications have occured (7.4%). Two late complications – a urostomy stenosis and a parastomal hernia needed surgical repair. Over a median follow-up period of 40 months, 9 (33.3%) patients have died. Median overall survival (OS) was 33 months (range 1–96 months). The primary pelvic exenteration survival rates were 83% at 2 years and 46% at 5 years, respectively.

Conclusion Primary pelvic exenteration might be associated with a low rate of intraoperative, but with possible postoperative complications which could be lethal. Its long-term survival is relatively high in trained teams.

Disclosures None

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