248 The experience in pelvic exenteration in patients with advanced and recurrent cervical cancer in Belarus

Objective To determine the efficacy of pelvic exenteration (PE) in patients with locally advanced, persistent and recurrent cervical cancer (CC). Methods A retrospective study was performed of 30 patients with locally advanced, persistent and recurrent CC who underwent PE in 2006–2012. Anterior PE was performed in 24 (80%) patients, posterior PE in 2 (7%) and total PE in 4 (13%). Results The mean operation time was 279.5 min. Urine derivation in 28 patients was performed in the following ways: 7 (25%) patients were subjected to ureterostomy, 21 (75%) had plastic interventions for neocyst formation. Fecal diversion performed in 5 patients by end colostomy (Hartman’s procedure) and in one patient rectum resection was performed. Radical surgery was performed in 70% (21 of 30) of the patients. The median follow-up time of the 28 patients was 76.3 months. During the follow-up period, 19 (68%) patients died of the underlying disease with no deaths of other causes. The median survival was 15.5 months, 5-year survival – 32% (SE 8.8%). The median survival after radical surgery was 37.9 months vs 5.5 months after nonradical one. Five-year cause-specific survival after radical surgery was 74% (SE 10.1%; 95% CI 49–91%), after nonradical one – 33% (SE 15.7%). Conclusion Surgical radicality has been established to be a clinically and statistically significant factor of death risk: the radical surgery enables to reduce the death risk 3.5-fold (95% CI 1.4–9.0; p=0.009), to increase the median survival 6.9-fold, 5-year survival from 11% (SE 10.5%) to 42% (SE 11.3%, 95% CI 20–67%).