Pelvic exenteration for carcinoma of the uterine cervix.A 15-year experience

Abstract

From 1954 to 1969, 162 patients at the National Cancer Institute were treated with pelvic exenterations for carcinoma of the uterine cervix. A total cumulative 5-year survival of 38% was obtained. Sixty-eight of these patients presented with large, previously untreated lesions not amenable to lesser curative therapy. Their actuarial 5-year survival was 48%. The remaining 94 patients were treated for radiation recurrent cancer with a 5-year actuarial survival of 28%. Positive pelvic lymph nodes did not affect prognosis in patients treated for primary cancer, but survival decreased to 11% in those patients with recurrent disease and positive pelvic nodes. The 30-day mortality was 7%, and the total intrahospital mortality was 17% (1 to 108 days). This mortality correlated with previous radiotherapy, patient age, preoperative medical status, operative time, and intraoperative transfusion requirements. Operative time and intraoperative transfusion requirements appeared to be related to the relative experience of the 17 surgeons involved in this study. Postoperative complications were similarly related to the above factors and have increased over the years in proportion to the degree that preoperative selection criteria have been liberalized. Over the 15 years encompassed in this study, there has been, however, a steady significant increase in cumulative 5-year survival. Criteria for patient selection for pelvic exenteration are outlined, and salient suggestions are made for operative and postoperative management.