Pelvic Exenteration and laterally extended endopelvic resection (LEER) for residual and recurrent carcinoma cervix: Experience at a tertiary cancer hospital

Ajit Agarwal, Rajaraman R and Hemanth Ra .


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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