Behandlungsergebnisse der exenterativen Eingriffe bei gynäkologischen Malignomen an der Frauenklinik im Klinikum Kassel

The objective of this study was to retrospectively assess and to describe the outcome of 66 patients, who underwent pelvic exenteration between 1991 und 2005 in the Gynaecological Clinic in Klinikum Kassel. Different clinical and histological factors associated with overall-survival as well as time to relapse were analyzed. The mean age of patients was 59 years. Thirty-three anterior, 24 total and nine posterior exenterations were performed. The most patients (57,6%) underwent exenterative surgery for cervical cancer. Recurrent malignancy was an indication in 39 patients. Nine patients underwent exenteration for palliation. Clear histological margins were achieved in 37 patients (56,1%). There were lymph node metastases in 45%. Bladder invasion was microscopically detected in 62%, rectal invasion was detected in 20 patients (30,3%). Low colorectal anastomosis for fecal diversion was performed in 14%, urinary diversion included ileal conduit (in 76%) and continent pouch diversion in 24%. Forty patients developed postoperative complications; the mortality rate was 6%. The morbidity was higher in the group of patients with a history of irradiation, in the incontinent urinary diversion group and in elderly patients, although no factor reached statistical significance. The 5-year-survival rate was 34%, the mean survival was 22 months. Thirty-seven patients developed recurrence of disease, there was a local recurrence in 25 cases, 12 patients developed distant metastases. The overall-survival was statistically better in patients with negative lymph node status, clear histological margins and in the group of patients undergoing the exenteration for cure. In summary, pelvic exenteration is an acceptable treatment of locally advanced or recurrent pelvic cancer. The following patients benefit mostly from the pelvic exenteration: patients in good general condition, without prior radiation therapy in the history, with negative lymph node status and clear histological margins. Pelvic exenteration for advanced ovarian cancer as well as exenteration for palliation is an option for specific group of patients. Appropriate patient selection and novel techniques can reduce complications and patient mortality and improve quality of life for patients with advanced pelvic malignancies.