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Indications, techniques and outcomes for pelvic exenteration in gynecological malignancy

Kaur, Manpreeta; Joniau, Stevenb; D’Hoore, Andréc; Vergote, Ignacea

doi: 10.1097/CCO.0000000000000109
GYNECOLOGIC CANCER: Edited by Martin Gore

Purpose of review To review recently published literature presenting an overview of the current insights and (clinical and technical) developments on pelvic exenterative surgery for gynecological malignancies.

Recent findings Lateral recurrences, positive pelvic node status, age and high body mass index should be abandoned as contraindications for pelvic exenteration. F-fluorodeoxyglucose positron emission tomography-computed tomography is a valuable imaging tool, especially for the detection of enlarged lymph nodes and for distinguishing fibrosis from recurrence. Combined omental plus vertical rectus abdominis myocutaenous flaps give significant reduction in complications, whereas fascia sparing (myo)cutaneous flaps seem promising in decreasing donor-site complications.

Summary Pelvic exenteration is indicated when curative alternatives are inferior or exhausted for advanced primary or locally gynecological recurrent cancer confined to the pelvis. Palliative pelvic exenteration should only be considered when disease-related morbidity is uncontrollable with other therapeutic modalities. Modifications in different surgical steps are still evolving to decrease the pelvic exenteration associated high morbidity. A complete resection and lymph node invasion free status are directly related to a better prognosis.

aDivision of Gynaecologic Oncology, Department of Gynaecology and Obstetrics

bDepartments of Urology

cAbdominal Surgery, Leuven Cancer Institute, European Union, KU Leuven, Leuven, Belgium

Correspondence to Ignace Vergote, MD, PhD, Department of Gynaecologic Oncology, University Hospitals of Leuven, Herestraat 49, 3000 Leuven, Belgium. Fax: +32 16 344629; e-mail: ignace.vergote@uzleuven.be

© 2014 Lippincott Williams & Wilkins, Inc.