Pelvic exenturation

Question 1

What is the most common indication for Pelvic exenturation?

Answer 1

Cervical cancer after primary radiotherapy

Question 2

What is the aim with pelvic exenturation?

Answer 2

R0 and cure

Question 3

how do you individualise the extent of PE?

Answer 3

The extent of the procedure can be tailored on three planes. It is not only a choice of one of the three basic PE types in a sagittal pelvic plane among anterior, posterior, and total. Equally relevant is the craniocaudal extent, with the possibility of preserving the vulva, vagina, and urogenital diaphragm. Moreover, the majority of lateral tumors are not located centrally, which enables significant adjustments to the radicality on each side of the pelvis in the frontal plane.

Question 4

what should you take in to consideration when planning a PE?

Answer 4

1. localization of the recurrent tumor should be taken into account
2. extent of the disease before primary treatment (i.e., infiltration to other pelvic structures)
3. the radiation dose received by the adjacent organs.

Question 5

What is a type I pelvic exenturation

Answer 5

Supralevator type I (preserving endopelvic fascia and pelvic diaphragm)

Question 6

What is a type II pelvic exenturation

Answer 6

Type II PE can be performed with a resection of the levator ani muscle but with preservation of the urogenital diaphragm and distal vagina (type IIA), or with total vaginectomy and resection of both pelvic and urogenital diaphragms (type IIB)

Question 7

What is a type III pelvic exenturation

Answer 7

Including vulvectomy

Question 8

When can you do a colorectal anastomosis in PE?

Answer 8

Type I and IIA posterior exenteration usually enables the surgeon to make a colorectal anastomosis

Question 9

What are the goals of imaging pre-op to PE?

Answer 9

1. diagnosis of the recurrence
2. exclusion of distant metastases (via PET-CT)
3. assessment of the local extent of the disease.

Question 10

What are the 5 year survival rates post PE for those with recurrence

1. less than 2 years
2. 2-5 years
3. over 5 years

Answer 10

Marnitz reported 5-year survival rates in patients with a recurrence

up to 2 years: 17%

between 2 and 5 years: 28%

more than 5 years: 83%

Question 11

Prognostic factors when considering PE

Answer 11

positive pelvic and paraaortic LNs

lateral pelvic attachment

histologic types

the disease-free interval from the primary treatment

or the presence of symptoms at the time of diagnosis.

patient factors - age, comorbidity, obesity, previous surgery, previous RTX, patient choice/motivation