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Pelvic exenteration for recurrent gynaecological cancer after radiotherapy
Author(s) -
Kolomainen Desiree F,
Barton Desmond PJ
Publication year - 2017
Publication title -
the obstetrician and gynaecologist
Language(s) - English
Resource type - Journals
eISSN - 1744-4667
pISSN - 1467-2561
DOI - 10.1111/tog.12383
Subject(s) - medicine , pelvic exenteration , quality of life (healthcare) , radiation therapy , surgery , general surgery , disease , stage (stratigraphy) , nursing , paleontology , biology
Key content Exenterative procedures for recurrent gynaecological cancers are uncommon and present clinical challenges. A multidisciplinary approach is key to optimising patient outcome. Surgery is undertaken in almost all cases with curative intent, and rarely with palliative intent. Only complete histological clearance of disease (R0 resection) is associated with long‐term survival, but not in all cases. There is an absence of level 1 evidence and national guidelines.Learning objectives Understand the factors that are important in case selection. Appreciate that case selection is individualised and surgery is associated with a high morbidity and mortality rates. Understand the two components of exenterative surgery: (1) complete resection of the cancer (R0) and (2) reconstruction/restoration of pelvic functions. Most exenterations are performed for recurrent disease involving the central pelvis. Recently, radical surgery has been undertaken with favourable outcomes for pelvic sidewall disease.Ethical issues There is a paucity of data on quality‐of‐life assessment in patients undergoing exenterative surgery for recurrent gynaecological cancers. Prolonged survival may not translate into improved or acceptable quality of life. Following success from the centralisation of cancer services, consideration needs to be given to commissioning exenterative procedures in fewer centres in the UK.