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.
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.
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