Surgical therapy and exenteration for advanced cervical cancer – literature review
Affiliation and adress for correspondence

1 Department of Gynecology and Obstetrics, Essen, Germany. Head of the Deparment: Prof. med. Rainer Kimmig
2 Clinical Department of Gynecologic Oncology, Professor Franciszek Łukaszczyk Oncology Center in Bydgoszcz, Poland. Head of the Department: Professor Łukasz Wicherek, MD, PhD
3 Department of Surgical Oncology and Urology, Maria Skłodowska-Curie Institute of Oncology, Division in Krakow, Poland. Head of the Department: Professor Jerzy Mituś, MD, PhD
4 Clinical Department of Urologic Oncology, Professor Franciszek Łukaszczyk Oncology Center in Bydgoszcz, Poland. Head of the Department: Jerzy Siekiera, MD, PhD
5 Microbiology Division, Professor Franciszek Łukaszczyk Oncology Center in Bydgoszcz, Poland. Head of the Division: Maria Szymankiewicz, MD, PhD
6 Department of Gynecologic Oncology, Maria Skłodowska-Curie Memorial Cancer Center and Institute of Oncology in Warsaw, Poland. Head of the Department: Professor Beata Śpiewankiewicz, MD, PhD
7 Department of Gynecologic Oncology, Maria Skłodowska-Curie Institute of Oncology, Division in Krakow, Poland. Head of the Department: Professor Krzysztof Urbański, MD, PhD
8 Department of Gynecologic Oncology and Gynecologic Nursing of the Collegium Medicum at Nicolaus Copernicus University in Bydgoszcz, Poland. Head of the Department: Professor Łukasz Wicherek, MD PhD
Correspondence to: Professor Łukasz Wicherek, MD, PhD, Clinical Department of Gynecologic Oncology, Professor Franciszek Łukaszczyk Oncology Center, Romanowskiej 2, 85-796 Bydgoszcz, Poland, tel.: +48 52 374 33 99, +48 52 374 38 74, e-mail: mowicher@cyf-kr.edu.pl
Acknowledgments
We would like to express our deepest thanks to Zbigniew Pawłowicz, MD, PhD and Professor Jerzy Stelmachów, MD, PhD for their support, helpfulness, and ability to predict the direction of development in medicine. Photos presented in the manuscript were taken during the course of exenteration procedures performed in the Clinical Department of Gynecologic Oncology of the Oncology Center in Bydgoszcz – thanks to Wojciech Polonceusz, MD, PhD and Naser Alahmad Alali, MD, PhD.

CURR. GYNECOL. ONCOL. 2014, 12 (2), p. 125–139
DOI: 10.15557/CGO.2014.0012
ABSTRACT

While the surgical technique of exenteration has been around for 60 years now, recent progress in the development of reconstructive surgery has created new opportunities for gastrointestinal and urinary tract anastomosis. As pre- and postoperative care has improved and indications for the exenteration procedure have became more precise, the outcomes of the treatment for advanced malignant pelvic tumors have also improved. Consequently, the perioperative mortality rate has decreased from the 28% specified by Brunschwig to the present rate of 3%. Moreover, the number of complications resulting from such complex procedures has decreased. Today, postoperative complications are no longer a factor that impacts how eligibility for exenteration is decided. It has been demonstrated that the quality of life of patients subject to exenteration procedure compared to those having palliative chemotherapy is lower in the first months following surgery, but is higher in the long-term follow-up beginning 9 months after the procedure. At the same time, multiple studies have unambiguously demonstrated that the overall five-year survival rate in patients with cervical cancer recurrence after radiation therapy is the longest upon exenteration and, subject to strict following of the indications for the procedure, allows a survival rate of 50% to be exceeded in this group of patients. Since the exenteration procedure is the culmination of a combined treatment, eligibility for such a procedure should entail multiple factors related to the course of treatment and the biology of a given neoplasm and should be decided only by an interdisciplinary team composed of at least a radiation therapist, a gynecologist-oncologist, and a clinical oncologist. Also, surgery of this kind is of a disciplinary nature therefore the procedure should be performed only in a reference site employing gynecologists, oncologists, urologists, and oncological surgeons who have comprehensive surgical experience. Only sites that employ such health care professionals allow for the safe performance of the exenteration procedure.

Keywords: cervical cancer, exenteration, cervical cancer recurrence, para-aortic lymphadenectomy, “empty pelvis” syndrome