Pelvic Exenteration (PE) in Gynecological Cancers: Indications, Complications and Overall Survival (OS) Analysis

Background & Objective: The surgical procedure known as pelvic exenteration (PE) involves removing lower abdominopelvic structures as a single unit. Despite its high morbidity, this procedure is primarily used to manage advanced primary or locally recurrent pelvic cancers. Our study aims to assess our experiences with PE over the past 8 years. We identified patients who underwent pelvic exenteration for gynecological cancers between 1 January 2011 and 31 December 2019 through hospital records.Materials & Methods: We retrospectively analyzed patient characteristics, procedural indications, surgical details, and patient outcomes. Overall survival (OS) was analyzed using the Kaplan-Meier method and log-rank test, while Cox proportional hazards regression was used to model survival outcomes.Results: Twenty-one patients with recurrent cervical, endometrial, ovarian, and/or vaginal cancer underwent pelvic exenteration. Local disease recurrence accounted for 80.9% of procedural indications, with 80.9% originating from the cervix and 9.5% from the endometrium. Sixty-two percent underwent PE with curative intent, while 38% had palliative objectives. Wound infection was the commonest early complication, and late complications included deep vein thrombosis, lymphocyte formation, and recurrent urinary tract infections. Median survival rates were 85.7% at 6 months and 57.1% at 12 months. Our five-year OS, as calculated using the Kaplan-Meier method, was 54.3% (95% CI 34.2, 74.6).Conclusion: Our case series demonstrates that pelvic exenteration offers approximately a 54.3% 5-year survival chance in a selected cohort of patients. Early and late complication rates align with historical descriptions. Pelvic exenteration leads to sustained survival in specific patients, and ongoing efforts should prioritize identifying those who could benefit most from this procedure.