Department of Surgery, Gynecology Service, Memorial Sloan-Kettering Cancer Center, New York, NY 10065, USA.
Gynecol Oncol. 2012 Jan;124(1):42-7. doi: 10.1016/j.ygyno.2011.09.031. Epub 2011 Oct 20.
To evaluate the outcomes observed with pelvic exenteration with curative intent for recurrent uterine malignancies in the modern era.
We reviewed the records of all patients who underwent this procedure at our institution between 1/1997 and 03/2011. Postoperative complications up to 90 days after surgery were analyzed and graded as per our institution grading system. Survivals were estimated using the Kaplan-Meier method.
During the study period, 21 patients were identified. Median age at the time of exenteration was 57 years (range, 36-75). Median tumor size was 6 cm (range, microscopic - 14.5). Tumor histology was: endometrioid, 10 cases; mixed, serous, and carcinosarcoma, 7 cases; and sarcomas, 4 cases. The type of exenteration was: total, 14 cases; anterior, 6 cases and posterior, 1 case. There were no intra- or postoperative mortalities. Seven patients (33%) developed at least one grade 2 complication, and 10 patients (48%) developed at least one grade 3 complication. Five (24%) patients had to be re-operated on in the first 90 days post surgery. The median follow up time after exenteration was 39 months (range, 5-112). The 5-year survival of the entire cohort was 40% (95% CI: 18-63). An improved survival was observed in patients with endometrioid tumors and sarcomas (5-year survival rates of 50% and 66%, respectively). The presence of pelvic sidewall involvement and/or hydronephrosis did not negatively affect survival.
Pelvic exenteration for recurrent uterine malignancies can be associated with long-term survival in properly selected patients. A high rate of postoperative complications remains a hallmark of this procedure and should be discussed carefully with patients facing this decision.
评估现代时代以根治为目的进行的盆腔廓清术治疗复发性子宫恶性肿瘤的结果。
我们回顾了 1997 年 1 月至 2011 年 3 月期间在我们机构接受该手术的所有患者的记录。分析了手术后 90 天内的术后并发症，并按照我们机构的分级系统进行分级。使用 Kaplan-Meier 方法估计生存率。
在研究期间，共确定了 21 名患者。盆腔廓清术时的中位年龄为 57 岁（范围 36-75 岁）。中位肿瘤大小为 6 厘米（范围为显微镜下 - 14.5 厘米）。肿瘤组织学类型为：子宫内膜样癌 10 例；混合性、浆液性和癌肉瘤 7 例；肉瘤 4 例。盆腔廓清术的类型为：全盆腔廓清术 14 例；前盆腔廓清术 6 例，后盆腔廓清术 1 例。无术中或术后死亡。7 名患者（33%）至少发生了 1 级 2 种并发症，10 名患者（48%）至少发生了 1 种 3 级并发症。5 名患者（24%）在手术后的前 90 天内需要再次手术。盆腔廓清术后的中位随访时间为 39 个月（范围 5-112 个月）。整个队列的 5 年生存率为 40%（95%CI：18-63）。子宫内膜样癌和肉瘤患者的生存情况得到改善（5 年生存率分别为 50%和 66%）。骨盆侧壁受累和/或肾盂积水的存在并未对生存产生负面影响。
适当选择的患者进行盆腔廓清术治疗复发性子宫恶性肿瘤可以获得长期生存。高术后并发症发生率仍然是该手术的标志，在面临这一决策的患者中应仔细讨论。
