Pelvic Exenteration and laterally extended endopelvic resection (LEER) for residual and recurrent carcinoma cervix: Experience at a tertiary cancer hospital
Abstract
Introduction: Concurrent chemoradiation (CCRT) is
standard of care for the patients with locoregionally
advanced carcinoma cervix. Up to 45% patients can have
residual disease after CCRT. Five years progression free
survival (PFS) ranges from 46-63% based on stage of the
disease. Pelvic exenteration and LEER are options in
the management of carefully selected patients with
residual or centrally recurrent carcinoma cervix after
CCRT. Aims and Objectives: We present a series of
3 consecutive cases of residual and recurrent carcinoma
cervix post CCRT managed with Pelvic exenteration and
laterally extended endopelvic resection (LEER) during a
period of 2012-2016. Patients and methods: These three
consecutive patients were diagnosed with locally advanced
carcinoma of the cervix (IIA2-IIIB) and received Cisplatin
based CCRT as primary treatment. Two patients who had
residual disease after the treatment and one who
had recurrence after disease free survival of 18 months
were managed with anterior pelvic exenteration and LEER
respectively. The diagnosis was Adenocarcinoma
carcinoma in one patient, Adenosquamous in second and
Squamous cell carcinoma in the third patient. Two patients
had stage FIGO Stage IIA2 disease and one had III B
disease. Results: The mean age of the patients was
41.6 years. Average duration of surgery was 6.67 hours,
mean blood loss was 700 ml and all patients underwent
margin negative excision. The mean blood transfusion was
3 units in the perioperative period. Infectious complications
developed in 2 patients and one patient developed renal
dysfunctions requiring dialysis. The mean postoperative
hospital stay was 24 days. The mean follow up duration is
28 months (12-59 months). One patient developed stomal
stenosis and required refashioning.
One patient developed recurrence after 33 months of surgery
and received palliative chemotherapy for the same. She is
alive with disease till last follow up (July 2017). In Anterior
pelvic exenteration group one patient is disease free
12 months post surgery and second patient died 13 months
after surgery due to renal complications. Conlusion: Pelvic
exenteration and LEER are surgical options in cases of
recurrent and residual advance carcinoma cervix treated
primarily with CCRT. Patient selection is of utmost importance
and margin negative resection should be the surgical aim.
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