PELVIC EXENTERATION FOR THE TREATMENT OF GYNECOLOGICAL MALIGNANCIES

Twenty-three patients undergoing pelvic exenteration for primary and r ecurrent gynecological malignancies from 1976 to 1994 are reported. Fi fteen patients underwent total pelvic exenteration, 3 underwent anteri or exenteration, and 5 underwent a posterior procedure. Eight patients had exenteration as their primary treatment (primary group), and 15 u nderwent exenteration as secondary treatment (recurrent group). In the primary group, two patients developed recurrence and died of it at 6 and 20 months after operation. Five patients are still being followed up and are alive without disease. Four of these 5 patients have surviv ed more than 5 years. In the recurrent group, 12 patients were followe d up and three died of complications during the early years. Seven pat ients died of cancer with the mean survival time of 16.6 months. The m ean age, average operating time, and mean blood loss in the primary an d recurrent groups were 57 vs. 53 years, 8 hours and 20 min vs. 8 hour s and 10 min, and 4,120 vs. 4,190 ml, respectively. The overall cumula tive 5-year survival rate was 34.7%, being 68.6% in the primary group and 16.7% in the recurrent group. It is noteworthy that the 5-year sur vival rate was 51.3% in the patients who had surgical margins free of disease. In conclusion, pelvic exenteration should be considered an ac ceptable therapeutic option when appropriately selected.