GYNECOLOGIC ONCOLOGY Should pelvic exenteration for symptomatic relief in gynaecology malignancies be offered? P. Pathiraja • H. Sandhu • M. Instone • K. Haldar • S. Kehoe Received: 28 January 2013 / Accepted: 30 August 2013 / Published online: 12 September 2013 Ó Springer-Verlag Berlin Heidelberg 2013 Abstract Objective To review the outcomes of pelvic exenterative surgery done with a palliative intent and evaluate its role in relapsed gynaecology malignancies. Method This is a retrospective cohort study between April 2009 and May 2012 in Oxford Gynaecological Cancer Centre. Patients were identified from the oncology surgical database. Results 18 patients were identified with a mean age 54 (26–79) years, who underwent surgery for symptomatic recurrent cancer. All except one patient had radiotherapy prior to surgery. 12 patients had cervical cancer, five had vulval cancer and one had endometrial cancer. About half of the patients had major surgical complications; however, majority was patients satisfied with the outcome. Conclusion Pelvic exenteration in this context carries considerable morbidity and in this series achieved good symptom control with a mean overall survival of 11 months. Careful patient selection, adequate counselling and ongoing support are imperative of successful outcome. Keywords Exenteration Á Pelvic malignancy Á Recurrent gynaecology cancer Introduction Pelvic exenteration is described as radical resection of multiple pelvic organs, with reconstruction or diversion of visceral functions. Exenterative surgery was developed in the 1940s in the USA and was first reported by Alexander Braunschweig in 1948 for the treatment of persistent or recurrent gynaecological cancer. This published series was of patients treated with exenteration for palliation of symptoms caused by locally advanced pelvic malignancies. The majority of procedures were carried out for cervical malignancies resistant to radiotherapy [1]. With improved surgical technique the role of exentera- tion has changed from palliation to potential cure. Various modifications of exenteration surgery (e.g. anterior, pos- terior, supra-levator and infra-levator) have been attempted to reduce the high surgical morbidity that is associated with total pelvic organ resection [2]. Over the years various classifications with regards to indications for pelvic exen- teration have been described [3]. Although treatment-related mortality has fallen to \ 5% following exenteration, incidents of severe morbidity remain above 50 % [4]. The impact on body image and sexuality is significant issue following exenterative surgery [5–7]. Exenterative surgery for symptom control or palliation remains controversial. In this study, we evaluated the short- term surgical outcomes including complications. Method Identification of patients A retrospective analysis was performed on 18 individuals with advanced gynaecological cancer who underwent ex- enterative procedures for symptomatic relief between October 2009 and January 2012. Patients who underwent exenteration with curative intent were excluded from the study. Institutional clinical governance department approval P. Pathiraja (&) Á H. Sandhu Á M. Instone Á K. Haldar Á S. Kehoe Oxford University Hospital, Headington, Oxford OX3 7LJ, UK e-mail: pupath@gmail.com; ppathiraja@nhs.net 123 Arch Gynecol Obstet (2014) 289:657–662 DOI 10.1007/s00404-013-3023-5