PREOPERATIVE EVALUATION OF TUMOR EXTENSION IN PATIENTS WITH RECURRENTCERVICAL-CANCER

Background. Pelvic exenteration is an option in the treatment of local ly recurrent cervical cancer. Various preoperative diagnostic procedur es in the estimation of tumor invasion of the bladder and rectum or ly mphonodal involvement were evaluated. Design. The sensitivity and spec ificity of cystoscopy, intravenous pyelography, irrigoscopy, rectoscop y, and computed tomography were evaluated by comparing the preoperativ e findings with the histological result as the 'golden standards'. Res ults. In the assessment of bladder invasion the sensitivity of cystosc opy intravenous pyelography and computed tomography was 22.2%, 55.6% a nd 55.6%, respectively. The overall sensitivity of the three diagnosti c procedures was 77.8%. in the assessment of invasion of the rectum ir rigoscopy, rectoscopy and CT revealed a sensitivity of 33.3%, respecti vely. Only 50% of all cases with tumor infiltration of the rectum show ed positive results when all three diagnostic procedures were combined . The sensitivity and specificity of computed tomography in the diagno sis of lymphonodal involvement were 75% and 83.3%, respectively Conclu sion. We think that there is an obvious necessity for all diagnostic p rocedures for patient selection prior to pelvic exenteration. However, all these investigations are not conclusive but complement each other . Prior to pelvic exenteration, critical interpretation of all preoper ative diagnostic procedures is mandatory, otherwise surgery results in an unintended palliative procedure.