Dados do Trabalho

Título

Pelvic exenteration on recurrent cervical cancer: A systematic review of the main indications and prognosis

Introdução

Cervical cancer is the fourth most common malignant neoplasm among women worldwide, in low-income countries, the diagnosis is usually late and occurs at advanced stages, with the recommendation of exclusive chemoradiotherapy. If this initial approach fails, with clinical signs of persistent disease or tumor recurrence, pelvic exenteration becomes a therapeutic option to be considered. Pelvic exenteration is a radical surgical approach that aims to completely remove the tumor with free oncologic margins. This usually requires en bloc resection of pelvic organs, including the genital, urinary, and digestive tracts.

Objetivo

Describe the main indications and prognosis of patients after pelvic exenteration for cervical cancer

Casuística

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Método

This systematic review of published literature was carried out according to a predefined protocol, studies published in the last 10 years were identified through an electronic search of the US National Library of Medicine (MEDLINE), strategy used: (Cervical Cancer OR Cancer of the Cervix) AND (Pelvic exenteration OR Salvage Surgery). The title and abstract of each study was examined for relevance with full text being obtained for all potentially relevant studies. Studies were included regardless of design, with both trials and observational studies being eligible for inclusion.

Resultados

Patients diagnosed with locally advanced or recurrent pelvic malignancies seem to have poor response rates to chemoirradiation and the only potential curative solution is represented by pelvic exenteration. Selecting the correct patient is extremely important to reduce the number of perioperative complications, and achieve better oncologic outcomes. Consequently, the individualized selection of patients who would benefit from salvage surgery and confirmation of residual disease with biopsy is pivotal before performing salvage surgery. Delay to recurrence after initial treatment impacted overall survival in some series in the literature, along with that, tumor recurrence size up to 5 cm, lymph node, perineural or lymphovascular invasion, surgical margins invaded after exenteration were also factors related to poor prognosis after the surgery. Regarding histologic grade, grade 3 and undifferentiated tumors are associated with higher mortality. Over the years, mortality rates have decreased, and overall survival has reached values close to 50% at 5 years, making it a possible curative procedure. However, complications like bleeding, ileal or small bowel obstruction, surgical wound changes, sepsis and thromboembolism are still common and potentially serious. Because of the impact on quality of life, the procedure should always be individualized and considered by the patient and the multidisciplinary team.

Conclusões

Pelvic exenteration remains a demanding surgical procedure which still associates a high risk of postoperative complications, although initially the long-term outcomes were poor due to the tumor extension, a significant benefit of survival has been observed, especially since the studies regarding the process of local invasion and relapse of such tumors has been better understood and allowed a more specific and personalized surgical treatment for each patient.

Referências

BACALBASA, N. et al. Pelvic Exenteration for Locally Advanced and Relapsed Pelvic Malignancies – An Analysis of 100 Cases. In Vivo, v. 33, n. 6, p. 2205–2210, 2019.

CONTE, C. et al. Assessment of Salvage Surgery in Persistent Cervical Cancer after Definitive Radiochemotherapy: A Systematic Review. Medicina, v. 59, n. 2, p. 192–192, 18 jan. 2023.

‌GRIMES, W. R.; STRATTON, M. Pelvic Exenteration. Disponível em: . Acesso em: 3 maio. 2024.

IMEN OURAOUI et al. Survival After Pelvic Exenteration for Cervical Cancer. Journal of obstetrics and gynecology of India, v. 72, n. 1, p. 66–71, 11 jun. 2021.

LI, L. et al. Pelvic Exenteration for Recurrent and Persistent Cervical Cancer. Chinese Medical Journal, v. 131, n. 13, p. 1541–1548, 5 jul. 2018.

STANCA, M.; CĂPÎLNA, D. M.; CĂPÎLNA, M. E. Long-Term Survival, Prognostic Factors, and Quality of Life of Patients Undergoing Pelvic Exenteration for Cervical Cancer. Cancers, v. 14, n. 9, p. 2346, 9 maio 2022.

TER GLANE, L. et al. Gynecologic Oncology: Pelvic Exenteration for Advanced or Recurring Cervical Cancer – A Single Center Analysis. Cancer Diagnosis & Prognosis, v. 2, n. 3, p. 308–315, 3 maio 2022.

‌UBINHA, A. C. F. et al. The Role of Pelvic Exenteration in Cervical Cancer: A Review of the Literature. Cancers, v. 16, n. 4, p. 817, 1 jan. 2024.

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Palavras Chave

câncer de colo de útero; EXENTERAÇÃO PELVICA; neoplasias do colo do útero; Prognostic Factors.; mortalidade; Complications; oncologia cirúrgica