Operative Prognostic Scores for Pelvic Exenterations for Gynecological Cancer: When Should we Operate?

Abstract

Purpose: Pelvic exenteration (PE) for locally advanced gynecological cancer or local recurrence is in some cases the only option. Because of the impact of this major surgery, our objective was to identify prognostic factors in order to establish an operative prognostic score. Methods: Patients were characterized by age, type of PE (anterior, posterior, total, atypical, preservation of pelvic floor and perineal excision, extended or not to other structures), indication, curative or palliative surgery and prior radiation therapy. Results: Over 30 years, 277 patients were included. 3 and 5-years overall survival was 36.8% and 32.3%. The rate of non curative resection was significantly correlated with posterior PE (OR: 2.29), tumors extending to the lateral pelvic wall (OR: 2.91), PE requiring enlargement (OR: 2.61) and lack of radiotherapy or <45 Gy (OR: 1.73). In multivariate analysis, factors significantly impacting survival were: total PE (HR: 2.04, p <0.0001), extended PE (HR: 1.56, p=0.017) and lack of radiotherapy or <45 Gy (HR: 1.40; p=0.033). Based on these factors, we created 4 different groups in order to establish a pre and post-operative prognostic score. Overall 5-years survival for each group was respectively 48.7%, 29.0%, 28.7% and 14.8% (p <0.0001). A preoperative high score was a strong negative predictive predictor of overall survival (HR=3.01, p <0.0001). Conclusion: These scores could help to predict overall survival and help decide when to perform this surgery.