Pelvic exenteration: prognostic significance of regional lymph node metastasis.

The members of the Felix Rutledge Society were surveyed to determine their policies concerning pelvic exenteration when regional lymph node metastasis is discovered at the outset of an operation and the resulting survival data. Survival data from the responding members are presented in a summary table. A series of 448 exenterations performed at The University of Texas M. D. Anderson Hospital and Tumor Institute from 1955 to 1984 was reviewed, and the medical records of patients with positive nodes were analyzed for factors that might influence prognosis, such as anatomical site of cancer, histologic type, and location and number of positive nodes. Of the 407 patients whose lymph nodes were studied histologically, 44 had nodal metastasis. Death from recurrent gynecologic cancer and death from all causes were used as end points, and survival rates were calculated according to primary treatment, treatment of recurrent cancer, cancer of the cervix, location of positive nodes, and number of positive nodes. For patients with positive nodes, 36.2% avoided death from recurrent cancer for 3 years, and 26.3% survived for 5 years. We conclude that although the prognosis for patients with positive nodes is poor, some longterm survivals can be achieved. The goal of pelvic exenteration is cure; however, for selected patients, the operation may be justified when it improves the quality of life and extends life.