Long term outcome and quality of life after pelvic exenteration for recurrent endometrial and cervical cancers

Charlotte Ngô, Christelle Abboud, Paul Meria, Virginie Fourchotte, Pascale Mariani, Bernard Baranger, Xavier Sastre, Caroline Malhaire, Anne-Cécile Philippe, Suzy Scholl, Anne de la Rochefordière, Séverine Alran

Departments of Medical Imaging, Institut Curie Gynaecological Cancer Study Group, Institut Curie, Paris, France.
Departments of Medical Oncology, Institut Curie Gynaecological Cancer Study Group, Institut Curie, Paris, France.
Departments of Pathology, Institut Curie Gynaecological Cancer Study Group, Institut Curie, Paris, France.
Departments of Radiotherapy, Institut Curie Gynaecological Cancer Study Group, Institut Curie, Paris, France.
Departments of Surgical Oncology, Institut Curie Gynaecological Cancer Study Group, Institut Curie, Paris, France.

DOI: 10.4236/ojog.2013.35A1005                

Abstract

Introduction: Pelvic exenteration can cure recurrent gynecological malignancies. However, treatment morbidity is over 50% in radiated pelves. We evaluated the outcome, the morbidity and the quality of life after exenteration. Methods: Patients who underwent an exenteration for recurrent cervical or endometrial cancer in our institution between 1999 and 2011 were retrieved. Survival rates were calculated according to Kaplan-Meier method and compared using the logrank test. The EORTC QLQ-C30 and QLQ-CX24 questionnaires were sent to patients alive in January 2012. Results: We identified 25 patients: 17 (68%) had cervical cancer and 8 (32%) endometrial cancer. 92% of them had received radiotherapy previously. All patients had a central pelvic recurrence, within a median time of 30 months [4 - 384] from initial treatment. Early complications requiring a re-laparotomy occurred in 9 patients (36%). Late complications included 2 (8%) fistulas, 2 (8%) occlusion and 1 (4%)

ureteral stenosis. Complete resection was obtained in 92% of patients. Disease Free and Overall survival rates were better in cervical rather than in endometrial cancer (median DFS in months 17 [2 - 145] vs 9.5 [3 - 21], p = 0.064, median OS in months 20 [2 - 145] vs 13 [4 - 42], p = 0.019). 69% of patients answered the quality of life questionnaires. Mean global quality of life score was 45 on a scale of 0 - 100, none of the patients had a sexual activity. Conclusions: Morbidity of exenteration remains high and quality of life is altered. Endometrial cancer is associated with a poorer prognosis. In those patients, exenteration should be put in balance with best supportive care.

Keywords

Pelvic Exenteration; Quality of Life; Recurrent Cervical Cancer; Recurrent Endometrial Cancer

Conflicts of Interest

The authors declare no conflicts of interest.

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