Maggioni Angelo, Roviglione Giovanni, Landoni Fabio, Zanagnolo Vanna, Peiretti Michele, Colombo Nicoletta, Bocciolone Luca, Biffi Roberto, Minig Lucas, Morrow C Paul
Division of Gynecologic Oncology, European Institute of Oncology, Via Ripamonti 435-20141, Milan, Italy.
Gynecol Oncol. 2009 Jul;114(1):64-8. doi: 10.1016/j.ygyno.2009.03.029. Epub 2009 May 2.
Analyze morbidity and survival after pelvic exenteration (PE) of gynecological malignancies.
We reviewed 106 consecutive patients with gynecologic malignancies who underwent PE from June 1996 to April 2007 at the Division of Gynecology, European Institute of Oncology (IEO), Milan.
PE was performed for cancer of the cervix (62 patients), vagina (21 patients), vulva (9 patients), endometrium (9 patients), ovary (4 patients) and 1 uterine sarcoma. Mean age was 53.6 (30-78) years. 97% of the patients received radiotherapy before PE and 3 patients had PE as primary treatment. We performed 53 anterior, 48 total and 5 posterior PE. Median operation time, estimated blood loss and hospital stay were respectively 490 (200-780) minutes, 1240 (300-6500) ml and 21.6 (11-55) days. No residual tumor was left in 93% of the patients. Median follow-up was 22.3 (1.6-117) months. There were no post-operative deaths (<30 days from surgery) nor intra-operative mortality. Total morbidity rate was 66%; 48% of patients had early complications (<30 days after PE) whereas 52 patients (48.5%) had late complications; 70% of these occurred to the urinary tract and 25% were due to bowel occlusions or fistulas. Overall survival was 52%, 35%, 19% and 16% respectively for cervical, endometrial, vaginal and vulvar cancer.
PE is a feasible technique with no post-operative mortality and high percentage of long-survivors, although the morbidity rate still remains significantly high. Careful patient selection, pre- and post-operative care and optimal surgical skills in a Gynecologic Oncologic Center are the cornerstones to further improve quality of life and survival for these patients.
分析妇科恶性肿瘤盆腔廓清术（PE）后的发病率及生存率。
我们回顾了1996年6月至2007年4月在米兰欧洲肿瘤研究所（IEO）妇科接受PE的106例连续妇科恶性肿瘤患者。
PE用于宫颈癌（62例）、阴道癌（21例）、外阴癌（9例）、子宫内膜癌（9例）、卵巢癌（4例）及1例子宫肉瘤。平均年龄为53.6（30 - 78）岁。97%的患者在PE前接受了放疗，3例患者将PE作为初始治疗。我们进行了53例前盆腔廓清术、48例全盆腔廓清术和5例后盆腔廓清术。中位手术时间、估计失血量和住院时间分别为490（200 - 780）分钟、1240（300 - 6500）毫升和21.6（11 - 55）天。93%的患者无残留肿瘤。中位随访时间为22.3（1.6 - 117）个月。无术后死亡（术后<30天）及术中死亡。总发病率为66%；48%的患者有早期并发症（PE后<30天），而52例患者（48.5%）有晚期并发症；其中70%发生于泌尿系统，25%由于肠梗阻或肠瘘。宫颈癌、子宫内膜癌、阴道癌和外阴癌的总生存率分别为52%、35%、19%和16%。
PE是一种可行的技术，无术后死亡率且长期生存者比例较高，尽管发病率仍然显著较高。在妇科肿瘤中心进行仔细的患者选择、术前和术后护理以及最佳手术技巧是进一步提高这些患者生活质量和生存率的基石。
