TREATMENT OF RECURRENT ADENOCARCINOMA OF THE ENDOMETRIUM WITH PELVIC EXENTERATION

Women with recurrent endometrial carcinoma are usually not considered candidates for pelvic exenteration, To assess the efficacy of this pro cedure, the records of all patients undergoing pelvic exenteration for adenocarcinoma of the endometrium at four institutions from 1955 thro ugh 1988 were reviewed, Of the 31 procedures performed, 7 were for pri mary therapy and 4 were judged to be palliative in nature and were exc luded from analysis, Of the 20 patients with recurrent endometrial can cer who underwent exenteration with curative intent, all had previousl y received pelvic radiotherapy, 14 as part of their primary treatment and 6 as part of the treatment of recurrent disease, Six of 20 patient s also received chemotherapy or hormonal therapy prior to exenteration , The median patient age was 65 years (range 44-79 years), At most rec ent follow-up, 8 patients were alive and disease free, 2 were alive wi th disease, 6 had died of disease, and 4 had died of other causes, The median follow-up of living patients is 89 months, Twelve of 20 patien ts experienced major complications, the most common of which was neova ginal flap necrosis, Of the 20 patients, 1 patient (5%) died in 1963 o f surgical complications, The Kaplan-Meier estimate of 5-year disease- free survival is 45%, Pelvic exenteration can produce an acceptable ra te of disease-free survival in highly selected patients with local rec urrence of endometrial adenocarcinoma who have exhausted other treatme nt modalities. (C) 1996 Academic Press, Inc.