Pelvic exenteration can be used to cure women with a central pelvic recurrence or persistence of gynecologic malignancy after initial definitive therapy. Refinements in patient selection, operative techniques, and surgical instrumentation have significantly improved outcomes over the past 60 years, but the procedure is still associated with significant mortality, morbidity, and recovery time. New technologies have made it possible to approach radical gynecologic surgeries in a minimally invasive fashion. We present 2 patients successfully treated with robotic-assisted anterior pelvic exenteration for treatment of persistent or recurrent cervical cancer after definitive radiotherapy.
Problem: significant blood loss; protracted recovery
Two women required anterior pelvic exenteration for recurrent cervical cancer. Patients undergoing conventional laparotomy can lose a significant amount of blood and require a lengthy hospital stay. One study indicates that patients are in surgery for 5-14 hours, sustain a blood loss of 2.3-4 L, and remain hospitalized for 19-37 days.
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Because our patients had previously undergone radiotherapy for cervical cancer, we anticipated that the tissues in the surgical field would be particularly fragile. The first patient was a 50-year-old woman with stage IVA squamous cell carcinoma of the cervix. Following definitive chemo-radiotherapy, she developed a vesicovaginal fistula, and biopsies revealed persistent cancer.
The second patient was a 58-year-old woman who had received radiotherapy 30 years earlier for locally advanced cervical cancer. She complained of pelvic pain and hematuria, and a subsequent physical examination revealed pelvic fibrosis and a vesicovaginal fistula. Cervical and bladder biopsies confirmed invasive squamous carcinoma. Positron-emission tomography/computerized tomography showed no metastases or hydronephrosis in either woman. Final pathology for both indicated negative surgical margins and lymph node involvement.
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